Question

A 235 lb. 59 y/o male is hospitalized after 3 days of nausea, vomiting and abdominal pain. During this illness, the Px lost 11 lbs. His medical history is unremarkable except for osteoarthritis that has developed from a torn anterior cruciate injury incurred when he was 18. He is currently taking Voltaren^® as needed for his osteoarthritis. He is taking no other medications. He complains for shortness of breath, fatigue, muscle weakness and some confusion. The physical exam shows the following:

                        Blood pressure            84/48 mmHg

                        Heart rate                     84 bpm

                        Breathing rate              24 breaths/min

                       

His admission lab values are below:

Blood			Urine (24 hr)
[Na+]	152 mEq/L		[Na+]	9 mEq/L
[K+]	6.8 mEq/L		[K+]	15 mEq/L
[Cl-]	111 mEq/L		[Cl-]	11 mEq/L
[HCO3-]	14 mEq/L		[HCO3-]	15 mEq/L
[Ca2+]	15 mg/dL		Creatinine	650 mg/dl
Creatinine	2.8 mg/dl		24 hr volume	350 ml
PCO2	29 mmHg		pH	4.8
pH	7.28		Osmolality	700 mOsm
BUN	68 mg/dL		Protein	1.5 mg/dL
PAH	0.15 mg/dL		PAH	150 mg/dL

a) From the physical exam and the lab data, what is your diagnosis? Defend your answer. (15 pts) (CALCULATIONS needed to explain diagnosis)

b)   Does the Voltaren have any effects on the Px’s condition? Why or why not? (10 pts)

c) Does the Px have an acid-base disorder? If so, what kind? (Defend your answer) Was this the cause or effect of the Px’s pathology? (10 pts.)

d)   Is the Px’s urine output normal, low or high? Why? (10 pts)

e) Is this pathology lethal and how would you treat this Px? (5 pts.)

NEED SPECIFICS PLEASE, details

Answer 1

a,From a physical exam patient complaint shortness of breath,fatigue,muscle weakness and some confusion..so there is a tablet side effects cause all this illness..common volfaren side effects include stomach pain,diarrhea,vomiting and nausea..so patient having same complaint for last 3days..due to this severe symptoms his blood pressure and heartrate gone low..Patient lab values shows low PH,low Hco3,loe PCo2,low urine output,high sodium,high potassium,high chloride,high ca2,high creatinine..it indicate patient had severe acidosis..when PH level go below 7.35 to 7.45 it will lead to acidosis and low paco2 and low Hco2 indicate metabolic acidosis..during metabolic acidosis patient will have high sodium,potasium,chloride,calcium,creatinine level..
b, Yes,volfaren tablet having many side efffects..it is a NSAID drug..its side effects include nausea,voimiting and abdominal pain and patient lost his weight also due to volfaren side effect..his urine output decreased and patient is in severe dehydration..
c, Yes, patient having acid-case disorder called metabolic acidosis..The cause for this condition patient had volfaren tablet for his osteoarthritis..it gave the side effects of nausea,voimiting and abdoiminal pain..his age also one reason he had metabolic acidosis due to severe dehydration..
d, patient urine output is low due to metabolic acidosis and dehydration..Fluid retention inside the body make low urine output.
e, Yes,there is patholofy lethal due to sudden onset of unknown ethiology..
Patient treatment include:
-shift the patient to intensive care unit in resuscitation area
-connect ECG,Sao2 monitor
-monitor continuous BP and hear rate
-check patient conscious level.
-Indubate the patient with doctor advice to make his breathing level normal
-Rehydrate the patient as soon as possible
-connect urine catheterization and measure urineoutput regularly
-repeat the lab values routinely