Question

Dale is 55 year old man who has been feeling ill over the last week. He has had episodes of vomiting and sweating. He assumes that he is suffering from the stomach flu that his grandchildren had two weeks ago. After not being able to “kick” the bug, he sees his family physician. The only other symptom he reports is a pulled muscle in his chest while shoveling snow about a week ago. Below are his chemistry results.

NA+	139 mmol/L	AST	70 U/L
K+	3.8 mmol/L	ALT	49 U/L
Cl-	104 mmol/L	CK	502 U/L
CO2	23 mmol/L	LD	365 U/L
Calcium	10.0 mg/dL	ALP	72 U/L
Phosphorus	3.9 mg/dL	Cholesterol	178 mg/dL
Glucose	105 mg/dL	HDL	19 mg/dL
BUN	24mg/dL	Triglycerides	424 mg/dL
Creatinine	0.9 mg/dL

Questions:

1. What laboratory tests are abnormal?
   
2. What other tests would be beneficial in the diagnosis of this patient?
   
3. Can we determine if this patient has had an AMI? Why or why not?
   
4. What were some factors that would increase Dale’s risk of an AMI?

Part III:

Samuel is a 38-year-old male gardener. He visited his family physician because of skin lesions on his hands that began as mild erythematous changes which developed into painful blisters. The blisters first began erupting during the late spring months. The patient indicated no history of allergic contact dermatitis or other drug or food allergies. The patient consumed about 3-4 12 oz. bottles of beer daily. He showed signs of facial hyperpigmentation with some scarring predominantly in regions of the forehead.

Na+	136 mmol/L
K+	4.5 mmol/L
Cl-	102 mmol/L
HCO3-	26 mmol/L
Glucose	163 mg/dL
BUN	13 mg/dL
AST	115 U/L
ALT	154 U/L
ALP	176 U/L

Questions:

1. What clinical symptoms suggest porphyria is present in this patient?
2. What lab data are consistent with a presumptive diagnosis of porphyria?
3. What is the most likely type of porphyria present in this patient? Why?
4. What additional lab data would be helpful in confirming the diagnosis?

Answer 1

The abnormal values are

• Increased BUN,AST,CK ,Triglycerides level
• Decreased HDL level

The other test which can be beneficial in diagnosis are

• Trop T
• Trop I
• CPKMB
• ECG

After an AMI, the CK level in the blood is raised.The CK is only released when there is an injury or insult to cardiac muscles or tissue.As the patients CK level is increased it indicates patient would have experienced an acute myocardial infarction

The main risk factor is the decreased level of HDL.A normal range should be above 40mg/dL.A decreased level is a risk factor to get coronary artery disease or cardiovascular disease

Part III

The following clinical symptoms in the patiwnt patient is suggedtive of porphyria

• Mild erythematosus skin lesions
• Painful blisters
• Facial hyoerpigmentation
• Scarring

The following lab tests are a consistent with presumptive diagnosis of porphyria

• Increased AST,ALT ,ALP happens when there is skin problem or a severe infection in it

The patient is experiencing cutaneous porphyria which means it affect the skin of the patients often causing lesions,painful blisters,rashes, hyperpigmentation,scarring on the skin

The additional lab test like checking the porphyrin level in the blood and urine can determine the confirmation of the diagnosis