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. Need to include Calculations.

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?

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

e) Is this pathology lethal and how would you treat this Px?

Answer 1