Question

A 20-year-old man was admitted to the intensive care unit. Consciousness is confused. It is known that during the last month, General weakness, spilled abdominal pain, nausea, and weight loss bothered. Blood pressure 85/50 mmHg. Blood chemistry: sodium 112 mmol /1, potassium 4.9 mmol/ I, glucose 3.70 mmol/ I, creatinine 88.4 mmol/ I, urea 1.5 mmol/I. The concentration of sodium in the urine is 80 mmol / I, the osmolarity of urine is 600 mOsm/kg. 1. Calculate the osmolarity of blood 2. What is the most likely cause of this condition? Explain your point of view. 3. Explain the mechanism of occurrence of these clinical and paraclinical manifestations of this condition. 4. What type of dyshydria (hypervolemia/hypovolemia) will be most characteristic of this condition? 5. What changes of acid-base balance may accompany this condition? Why?

Answer 1

1.Calculated osmolarity = 2 (Na+) + 2 (K+) + Glucose + Urea (all in mmol/L)   

= 2(112) + 2(4.9) + 3.70 +1.5 = 239 mmol/L

2. The man is in malnutrition

3. Because of not eating enough he has low glucose and urea level in his blood. This is also the reason for his weakness and confused consciousness.

4.Hypovolemia

5. Hypovolemic causes loss of fluids. Acute blood loss leads to decreased cardiac output, tachycardia, hypotension, and hypovolemic shock. Inadequate organ perfusion and oxygen delivery interfere with aerobic metabolism. Increased anaerobic metabolism leads to production of lactic acid and metabolic acidosis .