End-Stage Kidney Disease Sarah, a 63-year-old female with a past medical history
ID: 3523892 • Letter: E
Question
End-Stage Kidney Disease Sarah, a 63-year-old female with a past medical history significant for diabetes melitus, cirhosis gout, and a 30-pack a year smoking history presents to the emergency room with chest pain revealing pericarditis in the echocardiogram, secondary to recenitly diagnosed end-stage renal disease. Physical examination reveals yellowish discoloration to the skin and sclera, multiple bruises, 2+ bilateral edema, and weakness lasting more than three weeks. Her medications include Glisten, a new drug for diabetes that causes ATP sensitive potassium channels to close, thereby releasing insulin. Her recent laboratory results are as follows: CBC Glucose 126 mEqLp + 220 mmolL 0-100 7.1 mgldi 3.9 cells/ul Red blood cell count Vitals Blood Pressure Blood Gases 92/64 mmHg 7.28 30 mmHg 12 mmoluL CO2 Hormone Panel Renin ADH Low Vit D vit K Vit E Vit A Urine and Stool Sample Stool color Stool content Urine color Low Low Low Low Increased Fat Content Whine Please address each of the following regarding The case: 1. Explain the cause for her low calcium and sodium levels 2. Explain the cause of her anemia. What laboratory test should indicate she is suffering from anemia? 3. Explain the cause of her hypotension. How will her body attempt to establish 4. What type of acid-base disorder has she developed, and how will her body compensate? 5. Explain the cause of her elevated ADHH and glacose levels 6. What is the correlation between her ilinesses and the low vitamins (D. K, E, and A), renin and aldosterone levels? 7. Which homone would the body elevate in response to her low calcium levels? Why? 8. Explain the physiological reason behind her physical findings (yelowish hint of the skin sclera, multiple bruises, weakness, and edema) 9. Explain the cause of her abnormal stool and urine sample 10. What cell does Glisten work on? Explain how this medication is able to stimulate insulinExplanation / Answer
1. One of the major symptoms of diabetes mellitus is polyuria- release of excess urine from body. This is done in order to release excess sugar from body. Hence there is an increased loss of calcium along with sodium also.
2. She is suffering from renal disease. Kidneys secrete a hormone erythropoietin which stimulates bone marrow to produce RBCs. In renal disease, quantity of erythropoeitin produced becomes low. Hence amount of RBCs produced is low. RBCs contain hemoglobin which in turn contains iron. Hence anemia occurs.
Test used to detect anemia is complete blood count test which finds out our hemoglobin and hematocrit levels. Hematocrit measures the space taken up by RBCs in our blood.
3. Hypotension is one of the symptoms of diabetes mellitus. Dehydration occurs during diabetes mellitus to remove excess sugar from body. A person needs to urinate more often. Blood volume becomes low. Hence blood pressure decreases.
4. The amount of HCO3 levels given is less than normal. ph shown is also slightly less than normal. Condition is acidosis. There are two methods to control this- respiratory and renal compensation. In respiratory compensation, the person hyperventilates- excess CO2 is released. Inrenal compensation, there is removal of H+ and retention of HCO3- by kidneys.
5. In diabetes, the person tends to urinate more often, hence there is an increased water loss from body. Function of ADH is low decrease water loss from body, hence higher ADH amounts are secreted during diabetes.
In diabetes mellitus, there is low secretion of insulin, whose function is to utilise glucose for body's needs. Since insulin is not present inside the body because of diabetes, hence glucose cannot be utilised, leading to increase in its levels.
6. Low vitamin D causes weakness and fatigue.
Gray stool is a symptom of low Vitamin K.
Low Vitamin E and A also cause fatigue and weakness.
Renin causes an increase in blood pressure and causes vasoconstriction. Since amount of renin is low, blood vessels are dilated and hence blood pressure is low.
Aldosterone causes water and sodium reabsorption and increases blood volume. Thus blood pressure increases. Thus a decrease in aldosterone level causes hypotension and there is not any increase in blood volume.
7. Parathyroid hormone is released when blood calcium levels are low.
8. Yellowish skin and sclera is due to cirrhosis as there is an increase in bilirubin level, which is a low coloured pigment of the liver. This indicates that liver is not working properly.
Weakness is due to low levels of vitamins A,D and E in the blood.
Vitamin K is responsible for clotting. Its low levels suggest that blood is not clotting properly, suggesting bruises. High glucose levels in blood could also lead to wear and tear of blood vessels over time and cause bruising.
Cirrhosis is one of the causes of edema. Albumin levels decrease during cirrhosis and leads to fluid leaking out of the abdomen. Albumin maintains osmotic pressure and causes blood to stay within blood vessels.
9. Stool is gray because of vitamin k deficiency. Improper clotting leads to presence of blood in stool, leading to grayish black colour.
10. Glisten acts on beta cells of pancreas, as it releases insulin. It increases the amount of insulin secreted by the beta cells, thus reducing blood sugar level. It is an insulin secretagogue. It also increases activity of insulin receptors.
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