In: Biology
A 78-year-old female was arrived tired to the emergency room with the following symptoms: nausea, vomiting, decreased respiration, hypotension, and low pulse rate (46), The skin was not sweaty, it was warm, she is DM, swelling, she take some medication like metfromin 850mg, some diuretics, The patient had been treated for constipation and heartburn (antacids) within the last 24 hours.
Laboratory investigation resulted in the following:
Na+ |
133 mmol/L |
(136-145 mmol/L) |
K+ |
5.3 mmol/L |
(3.4-5.0 mmol/L) |
CL- |
95 mmol/L |
(98-107 mmol/L) |
Creatinine |
2.6 mg/dL |
(0.7-1.5 mg/dL) |
BUN |
40 mg/dL |
(5-20 mg/dL) |
Magnesium |
4.0 mmol/L |
(0.63-1.0 mmol/L) |
Total protein |
5.6 g/dL |
(6.0-8.0 g/dL) |
Albumin |
3.0 g/dL |
(3.5-5.0 g/dL) |
Calcium |
8.4 g/dL |
(8.6-10.0 g/dL) |
AST |
44 U/L |
(7-45 U/L) |
Fasting blood glucose |
162 mg/dL |
(75-115 mg/dL) |
HbA1c |
7.8 % |
(4.1-6.8 |
1. What explanation would you give the doctor for the difference in the electrolytes levels?
2. What is the most likely cause for the hypermagnesemia?
3. Which type of diabetes mellitus should be considered? And why?
type 2 diabetes.
4. What is your explanation for kidney function tests result (high Creatinine and BUN)? Is it indication for pyelonephritis or GFR dysfunction or acute kidney failure? Justify your answer.
5. Does the patient suffer from microalbuminuria regarding to albumin result? Justify your answer.
1. The difference in the electrolyte level is due to the medication given to the lady specially the constipation and heat burn antacid due to which the magnesium level has elevated
2. Hypermagnesemia is a condition which arises in the presence of elevated magnesium level
3. Type 2 diabetes. This is so because the lady was on medication of metformin which is the most preferred medication for diabetes type 2. Metformin lower down the blood glucose by restricting its production and enabling its removal by the liver
4. High level of Creatinine indicates impaired functioning of kidney as. Creatinine is produced as waste product from muscle activity. In case of high creatinine, doctor measures the Glomerular Filtration Rate (GFR). GFR tells the efficiency of kidney function. GFR mark below 30 indicates serious kidney damage and doctor may recommend dialysis or kidney transplant. Blood Urea Nitrogen (BUN) is a waste produced by break down of protein. With slow functioning kidney, the level of BUN rises.
5. The patient do not suffer from Microalbuminuria because it is a condition in which the level of urine albumin increase. Here in this case albumin level has reduced