What laboratory test assisted in the diagnosis of pancreatitis (1 mark)? What ty
ID: 239424 • Letter: W
Question
What laboratory test assisted in the diagnosis of pancreatitis (1 mark)?
What type of acid-base disturbance is suggested by the blood gas data (1 mark)?
What other lab tests might have been ordered to support this acid-base disturbance conclusion (1 mark)?
What is the significance of the serum sodium result (1 mark)?
Calculate the anion gap (show calculation) and determine if it is normal/increased/decreased (2 marks).
A measured serum osmolality is not provided. Calculate a theoretical “measured” serum osmolality using the sodium, potassium, chloride, bicarb, glucose, and BUN results (1 mark).
Calculate the osmol gap and determine if the results fit the clinical picture (2 marks).
What course of emergency treatment is suggested in this case (1 mark)?
What result(s) support a diagnosis of diabetes mellitus (1 mark)?
How is alcohol abuse a contributing factor to this disease (DM) (1 mark)?
What testing is recommended to monitor this patient after he returns home (1 mark)?
A 43-year-old man with a history of alcohol abuse was admitted to the emergency room complaining of weakness and bloody vomiting of a month's duration. During a recent hospitalization, he had been diagnosed as having pancreatitis and a urinary-tract infection. Subsequent blood and urine cultures grew Escherichia coli. However, the patient left the hospital against medical advice and prior to receiving treatment. He subsequently drank large amounts of alcohol, becoming weaker and unable to retain solid food. His reported liquid intake was increased by an unspecified amount. When this patient could no longer tolerate his weakened condition, he returned to the hospital emergency room. Initial evaluation in the emergency room revealed a lethargic, confused man with a 94 F temperature (recta). The physical exam was unremarkable except for a moderate Laboratory tests including serum chemistries, hematology studies, and arterial blood gases (ABGs) orn room air were drawn (Tables 1 and 2). Table 1 Serum Chemistry RI Hematology RI 23.6 x 103/ 4.98 x 10YuL 10.1 g 43.9 % WBC RBC HGB HCT MCV MCH MCHC PLT 4.0.11.0 4.5-6.5 13.0 18.0 40-54 77-93 27 32 33-37 130- 400 odium 104 ssium 3.1 chloride 70 HCO3 glucose 1443 mg BUN 38.9 mg/ creatinine 2.5 mg total calcium 8.5 mg/ 20.4 23.4 g/ 450 x 103/uL ALK 153 U/L ALT 28 U/L amylase 1050 U/L 50 136 3-36 23-85 total bilirubin 1.2 m Table 2 1 h after treatment 7.11 ABG Initial Result 6.95 HCO 21 mm Hg 22 mm Hjg 101 mm po TCO O2 saturation 94% 94%Explanation / Answer
1. Serum amylase. An increase of amylase in the blood usually indicates pancreatitis. in serum chemistry testtest, the patient has serum amylase level.1030 .
2. The reports suggests the patient is having metabolic acidosis as the blood PH and bicarbonate levels are extremely low.
3. Urine analysis is another test to confirm the diagnosis. As the differential diagnosis is made, certain other tests may be necessary, including toxicological screening and imaging of the kidneys
4. Sodium is the main extracellular cation, the importance of serum sodium is to distinguish the metabolic conditions. The patient is having Hyponatremia.
5. To distinguish between the main types of metabolic acidosis, a clinical tool called the anion gap is considered very useful. It is calculated by subtracting the sum of the chloride and bicarbonate levels from the sum of the sodium and potassium levels.
Sum of chloride and bicarbonate = 70+3 = 73
Sum of sodium and potassium. = 104 + 3.1 = 107.1
Anion gap. = 107.1 - 73.0 =34.1
Normally, this concentration is about 8-16 mmol/L (12±4). An elevated anion gap (i.e. > 16 mmol/L) can indicate particular types of metabolic acidosis, particularly certain poisons, lactate acidosis, and ketoacidosis.
8. The immediate treatment include administration of bicarbonate to avoid cardiac arrhythmia and administer fluids to maintain fluid balance. Sometimes require emergency dialysis also.
9. Blood glucose level of the patient is 1443mg / dl which is extremely high level and it indicate the diabetes mellitus of patient.
10.
11. After returning to home, the patient would be suggested to monitor serum electrolytes, liver function test, kidney functions as well as complete blood count.
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.