Question

J.V., a 56-year-old delivery truck driver, has been taken to the emergency department (ED) because he was experiencing chest pain. It started just after he had a quick lunch at a food truck. He told the paramedic that he often has chest pain but that it goes away when he "takes a swig of antacid," but this time the pain did not stop. On arrival he was given another dose of antacid and sublingual nitroglycerin, and the chest pain stopped. The first set of cardiac enzymes and basic metabolic profile (BMP) were drawn, and a 12-lead ECG was done. He weighs 275 pounds (125 kg), is 5 ft, 5 inches (165 cm) tall, and tells the nurse he has been overweight all his life. He said he'd had the chest pains for about 2 years but did not go to get checked because they always went away when he took antacids and he was too busy with work to go to a doctor. He works late hours, "lives on coffee," and grabs fast food when he has time to eat. He smokes 1.5 to 2 packs of cigarettes a day, has a beer every evening once he is home, and usually finishes a 6 pack on the weekends. Vital signs: T 98.9o F (37.2o C), P 110, R 14, BP 148/98. The test results are listed below.

TEST RESULTS

Sodium: 142 mEq/L (142 mmol/L)     Potassium: 4.1 mEq/L (4.1 mmol/L)

Chloride: 102 mEq/L (102 mmol/L)     CO2: 28 mEq/L (28 mmol/L)

Glucose: 168 mg/dL (9.3 mmol/L)     BUN: 12 mg/dL (4.3 mmol/L)

Creatinine: 1.1 mg/dL (97 mcmol/L)     Calcium: 5.1 mg/dL (1.28 mmol/L)

Hemoglobin: 14.8 g/dL (148 g/L)     Hematocrit: 48%

Cardiac troponin T: 0.05 ng/mL (0.05 mcg/L)     12-Lead ECG: Sinus tachycardia, rate 105

Review the test results and explain any abnormalities.

Answer 1

JV's test results

* sodium : 142mEq/L

Normal value ( range) of Sodium in the blood is 136- 145mEq/L.

* Potassium: 4.1mEq/L

Normal range of potassium in the blood is 3.5- 5.0mEq/L

* Chloride : 102mEq/L

Normal Range of Chloride is 98- 106mEq/ L

Sodium, Potassium and Chloride are the common electrolytes that are tested in the lab to identify any electrolyte imbalance. They are the minerals that have various functions in our body. Any abnormal range of these minerals may indicate electrolyte imbalance that may lead to many problems. example; Heart problems can be caused by low potassium levels.

JV does not have any electrolyte imbalances.

* CO2 : 28 mEq/L

CO2 level indicates the amount of Carbon dioxide in the blood. This test is also known as a Carbo dioxide test or a Bicarbonate test. Abnormality may indicate acidosis ( low bicarbonate) or alkalosis ( high bicarbonate content).JV' s CO2 level is normal. ( Normal range is 23- 29mEq/ L)

* Glucose: 168 mg/ dL ( 9.3mmol/ L)

Normal Blood Glucose level :70- 130mg/ dL ( fasting)

without fasting in non diabetic the Glucose level should be below 125mg/ dL ( 6.9mmol/L). (it can go upto 140mg/dL ( 7.8mmol/L).

JV's blood sugar level indicates a prediabetic condition. He is having  impaired glucose metabolism but not yet diabetic.

* BUN : 12 mg/ dL

* Creatinine: 1.1 mg/dL

Blood urea nitrogen ( normal range: 7- 20mg/ dL) and  Creatinine ( 0.6- 1.2 mg/ dL) are the indicators of kidney function. Increased level may show impaired kidney function.

No abnormality in BUN or creatinine inJV's blood.

* Ca : 5.1mg/ dL

Normal Calcium level may vary from 8.5 - 10.5mg/ dL. JV ' s Calcium level is low. He is having hypocalcemia

J.V' s Calcium level is low

* Hb : 14.8g/dL

Normal haemoglobin level : 13- 17g/dL. JV's Hb is normal

* Heamatocrit : 48% ( normal range is 45- 52%)

* Cardiac troponin T: 0.05 ng/ mL

( troponin released by heart after an injury to heart, example : Myocardial infarction. Normal range below 0.04ng/ml. The range may slightly vary as per labs. 0.05 can be considered as normal, even though it is very slightly increased )

* 12 lead ECG: Sinus Tachycardia , rate 105.

Sinus Tachycardia indicates increased sinus rhythm due to an increase in the rate of electrical impulses comes from SA ( sinoatrial node). Sinus Tachycardia is a condition characterised by increased heart rate above 100beats/ min.( Normal may range from 60- 90 in males). Sinus Tachycardia may occur due to physiological cause ( stress, exercise) or pathological cause ( anaemia, dehydration, heart problems etc.)

( Vital signs show increased Blood pressure and pulse rate)