Question

Case Study A

              Ms. KL is 50 yo, 5’6” (167.6 cm) tall, and currently weighs 105 lbs (47.7 kg). She has not been feeling well lately and made an appointment to see her primary care physician. Following the medical history/physical examination, the physician ordered a comprehensive metabolic panel and complete blood count with differential; several of these lab tests are reported below. In addition, the clinical nutritionist in the physician’s office estimated that KL’s dietary intake averages less than 1500 Kcal/day with ~ 20 g protein /day.

              Serum albumin                                              2.5 g/dl

              Serum transferrin                                         175 mg/dl

              Blood urea nitrogen (BUN)                           7 mg/dl

              Serum creatinine                                          0.8 mg/dl

              Hemoglobin (Hgb)                                          11 g/dl

              Hematocrit (Hct)                                            32 %

              Total lymphocyte count (TLC)               1450 cell/mm³

1. What is one plausible explanation for this patient’s low BUN level?

2. Comment on this patient’s serum creatinine level.

3. What is one explanation for this patient’s low visceral proteins levels?

4. Comment on this patient’s H & H (hemoglobin and hematocrit) values.

Case Study B

              Ms. HG is 20 yo, 5’8” (172.7 cm), and currently weighs 135 lbs (61.3 kg). She is experiencing fever, increased thirst, and polyuria; in addition, she suspects a urinary tract infection and thus made an appointment to see her primary care physician. She reported no recent change in appetite but reported losing a few pounds over the past month with no particular effort. Following a medical history/physical exam, the physician ordered a comprehensive metabolic panel, complete blood count, and urine culture. A subset of these lab tests are reported below.

              Plasma osmolality                                     325 mOsm/L   

Serum albumin                                          3.1 g/dl

              Plasma glucose                                          410 mg/dl

              Serum sodium                                            127 mEq/L

Serum potassium                                      3.2 mEq/L

1. Explain why this patient’s blood (serum) osmolality is elevated.

2. Explain why this patient’s electrolyte levels are low.

3. Explain why this patient is experiencing polyuria?

4. Assuming that this patient has adequate Kcal and protein intake, what explains her low    

    serum albumin level?

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Answer 1

A

1. A high BUN level may indicate that kidney is not working properly and is not removing urea from blood .it can help diagnose conditions such as liver damage,malnutrition,poor circulation,dehydration,urinary tract obstruction and congestive heart failure.So in this case the possible reason will be low intake of protein.The required protein needed for an adult women per day is46 gms.
2. In this patient serum creatinine level is normal.Normal level is from 0.6 to 1.2 mg/dl.
3. Visceral proteins are indicators of protein energy malnutrition.So the main reason for low visceral proteins in this case is due to inadequate dietary intake.Reduced levels of visceral proteins can be viewed as potential markers of inflammation and manifestations may include elevated or depressed WBC ,elevated temperature and hyperglycemia.
4. Hematocritis the volume percentage of red blood cells in the patients bloo with normal value ranges from 36-48% for females.Normal value of Hb in females is 12-16mg/dl.The ratio of Hb and Hct valuefor healthy people is 3 to 1.Rati is calculated by dividing Hct /Hb=32/11=2.9.less than 3.2 is normal,3.2-3.5 suggestive of haemoconcentration,greater than 3.5=haemoconcentration.In this case it is normal

B

1 Antidiuretic hormone controls serum osmolality.it usually increases when the patient experiences dehydration and decreases when the patient have a fluid build up.When it increases it triggers the body to make ADH .The patients kidney then keep more water inside the body and as a result urine becomes more concentrated.

2 if the patient has signs of dehydration or problems related to fluid level ,hyponatraemia occurs.This happens when the sodium levels ae too low and the body starts retaining fluid.

3Polyuria and elevated plasma osmolality despite a relatively high basal level of ADH suggests nephrogenic diabetes insipidus.