A 235 lb. 59 y/o male is hospitalized after 3 days of nausea, vomiting and abdom

ID: 151655 • Letter: A

Question

A 235 lb. 59 y/o male is hospitalized after 3 days of nausea, vomiting and abdominal pain. During this illness, the Px lost 11 lbs. His medical history is unremarkable except for osteoarthritis that has developed from a torn anterior cruciate injury incurred when he was 18. He is currently taking Voltaren® as needed for his osteoarthritis. He is taking no other medications. He complains for shortness of breath, fatigue, muscle weakness and some confusion. The physical exam shows the following:

Blood pressure 84/48 mmHg

Heart rate 84 bpm

Breathing rate 24 breaths/min

His admission lab values are below:

Blood

Urine (24 hr)

[Na+]

152 mEq/L

[Na+]

9 mEq/L

[K+]

6.8 mEq/L

[K+]

15 mEq/L

[Cl-]

111 mEq/L

[Cl-]

11 mEq/L

[HCO3-]

14 mEq/L

[HCO3-]

15 mEq/L

[Ca2+]

15 mg/dL

Creatinine

650 mg/dl

Creatinine

2.8 mg/dl

24 hr volume

350 ml

PCO2

29 mmHg

4.8

7.28

Osmolality

700 mOsm

BUN

68 mg/dL

Protein

1.5 mg/dL

PAH

0.15 mg/dL

PAH

150 mg/dL

a) From the physical exam and the lab data, what is your diagnosis? Defend your answer. (15 pts)

b) Does the Voltaren have any effects on the Px’s condition? Why or why not? (10 pts)

c) Does the Px have an acid-base disorder? If so, what kind? (Defend your answer) Was this the cause or effect of the Px’s pathology? (10 pts.)

d) Is the Px’s urine output normal, low or high? Why? (10 pts)

e) Is this pathology lethal and how would you treat this Px? (5 pts.)

(NEEEED DETAILS)

Blood

Urine (24 hr)

[Na+]

152 mEq/L

[Na+]

9 mEq/L

[K+]

6.8 mEq/L

[K+]

15 mEq/L

[Cl-]

111 mEq/L

[Cl-]

11 mEq/L

[HCO3-]

14 mEq/L

[HCO3-]

15 mEq/L

[Ca2+]

15 mg/dL

Creatinine

650 mg/dl

Creatinine

2.8 mg/dl

24 hr volume

350 ml

PCO2

29 mmHg

4.8

7.28

Osmolality

700 mOsm

BUN

68 mg/dL

Protein

1.5 mg/dL

PAH

0.15 mg/dL

PAH

150 mg/dL

Explanation / Answer

According to the information given in the question and the laboratory reports, these type of symptoms is found in the electrolytes imbalance in the body.

This condition is seen when the level of these electrolytes gets above or below its normal range or the required range of these electrolytes in the body.

These types of elements are the naturally occurring and play a vital role in important physiological functions of the body.

As these elements are mainly found in the blood and urine that’s why the test reports of blood and urine get disturbed in terms of electrolytes.

Besides these symptoms, the patient may also get suffer from the cardiac arrest and seizures as well.

In this type of disease, the normal ranges of electrolytes found in the body get disturbed.

In this disease, the patient suffers from the symptoms such as abdominal pain, high breathing rate, high heart rate, vomiting, nausea, and weight loss.

It can be caused due to a number of factors such as loss in body fluids, diarrhoea and sweating.

Even it can be caused due to the side effects of some medications.

There is a different type of electrolyte disorders found on the basis of which type of electrolyte is getting disturbed for example as there is a disturbance in the sodium levels then it can be known as hypernatremia and hyponatremia.

(b)

Diclofenac or Voltaren is the type of medication, which can be taken as an anti-inflammatory. This medication is taken by the patient for a long time.

It can be also used for the relief from pain, fever and inflammation.

It acts by reducing the production of prostaglandins.

It can be taken in the diseases such as osteoarthritis and rheumatoid arthritis.

The side effects of this drugs include heartburn, stomach pain, nausea, vomiting, and dizziness.

It also leads to the electrolytic imbalances in the body , which is shown in the blood and urine test reports.

Other than this it may also lead to the troubled breathing, high heart rate, seizures, loss of consciousness and fast heartbeat , which indicates the risk of respiratory and cardiac disorders as well.

Acidemia and alkalemia this two kind of conditions are found in terms of pH.

According to the patient blood test report, the pH is <7.28, which is lower than the normal range between <7.35->7.45.

It can be caused due to two factors first one is an alteration in the bicarbonate level of the serum and second one is the alteration in Pco2 level.

So, as the blood test reports, the bicarbonate level is also disturbed i.e, 14 mEq/L whereas the normal level is 23 to 30 mEq/L.

So disturbance in the bicarbonate level of the serum may cause the academia in the patient.

(d) Yes, the patient urine test reports are also disturbed.

All the electrolytes including sodium, potassium is found below its normal range.

For example, the normal level of sodium electrolytes is 20mEq/L and in the patient report, it is 11mEq/L.

This is also found as the side effect of the prolonged taking medication for the osteoarthritis.

And now the patient is suffering from the other symptoms as well, which is a high heart rate, breathing rate and high blood pressure, which is not good for health.

As it may cause the several disorders together such as endocrinal or kidney disorders.

Also, it may cause difficulty in the chemotherapy.

The nerve functions and muscle functions depend upon the electrolytic exchange between the inside and the outside cells.