Question

A 52-year-old man went to his physician for a physi- cal examination. The patient had been a district manager for an automobile insurance company for the past 10 years and was 24 pounds overweight. He had missed his last two appointments with the phy- sician because of business. The urinalysis dipstick finding was not remarkable. His blood pressure was elevated. The blood chemistry results are listed

Analyte	Patient Value	Reference Range
Na	151	135–143 mmol/l
K	4.5	3.0–5.0 mmol/l
Cl	106	98–103 mmol/l
CO2 content	13	22–27 mmol/l
Total Protein	5.7	6.5–8.0 g/d
Albumin	1.6	6.5–8.0 g/dL
Ca	7.9	9.0–10.5 mg/dl
Cholesterol	210	140–200 mg/dl
Uric Acid	6.2	3.5–7.9 mg/dl
Creatinine	2.5	0.5–1.2 mg/dl
BUN	95	7–25 mg/dl
Glucose	88	75–105 mg/dl
Total Bili	1.2	0.2–1.0 mg/dl
ALP	27	7–59 iu/l
LDH	202	90–190 iu/l
AST	39	8–40 iu/l
Amylase	152	76–375 iu/l

Questions 1. Given the abnormal tests, what additional information would you like to have?

2. If this patient had triglycerides of 100 mg/dL (1.1 mmol/L) and an HDL-C of 23 mg/dL (0.6 mmol/L), what would be his calculated LDL-C value?

3. If, however, his triglycerides were 476 mg/dL (5.4 mmol/L), with an HDL-C of 23 mg/dL (0.6 mmol/L), what would be his calculated LDL-C value?

Answer 1

1.

• Calculate BMI of the patient
• Monitor ECG
• Thyroid function test suc as T3, T4 and TSH.
• Calculate waist circumference

His Na level little bit high. If serum Na level elevated above 160mg/dl cause serious complication.

Metabolic acidosis and kidney disease occur if CO2 level is low. Here patient CO2 level is only 13.

Here patient kidney function test such as urea and creatinine are high and albumin level is significantly low. So check patient urine out-put and GFR. For more details Ultrasonography is essential.

2. Formula for LDL-C = Total cholestrol- HDL-C - Triglycerides/5

Here  total cholestreol = 210mg/dl

HDL-C = 23mg/dl

Triglyceride = 100mg/dl

Then apply formula to calculate LDL-C = Total cholesterol-HDL-C - Triglycerides /5

= 210mg/dl- 23mg/dl - 100mg/dl / 5

= 210- 23- 100/5

= 210-23-20

= 167mg/dl.

So answer is 167mg/dl.

3. Formula for calculating LDL-C Cholesterol = Total cholesterol- HDL-C - Triglycerides/5

Here triglycerides is = 476mg/dl

Total cholesterol = 210mg/dl

HDL-C = 23mg/dl

Apply formula for LDL-C = Total cholesterol- HDL-C- Triglycerides/5

= 210mg/dl- 23mgldl- 476mg/dl/5

= 210-23-476/5

= 210-23-95.2

= 91.8mg/dl

So answer is 91.8mg/dl