Case Study: A 52 year-year old man with a history of AIDS, hypertension, diabetes mellitus, and alcohol abuse was found unconscious in his home by his roommate. In the emergency department, he was hypotensive (103/60 mm Hg), febrile (temperature 101F), and unresponsive. Computed tomoggraphy scan of the abdomen showed choleccystitis and gallstones. Laboratory data are listed. The patient was diagnosed with acute renal failure. He was administered intravenous fluids; BUN fell to 68 mg/dL and creatinine fell to 2.2 mg/dL. The patients blood culture report was positive for e. coli. He was treated with tobramycin and cefepime. The patient continued to deteriorate and died 5 days after admission. Cause of death was multiorgan failure secondary to AIDS, sepsis, and alcoholic cirrhosis. DATA TABLE Drugs of Abuse Negative Urinalysis Serum ethanol 84mg/dL Hemoglobin Positive WBC 4 HPF (0-4) RBC 2 HPF (0-4) CK 3,308 U/L (24-204) BUN 71 mg/dL (8-21) CK-MB 15 ng/ml (0-7.5) Creatinine 4.1 mg/dL (0.9-1.5) Troponin T <0.01 ng/ml (0-0.4) Alkaline phosphatase 443 U/L (45-122) pH 7.50 Aspartate aminotransferase 305 U/L (9-45) pCO2 27 mm Hg Alanine aminotransferase 78 U/L (8-63) Total CO2 15 mmo/L Gamma glutamyl transpeptidase 724 U/L (11-50) Total bilirubin 2.7 mg/dL (0.2-1.0) Direct bilirubin 2.4 mg/dL (0-0.2) Questions: 1) What is the significance of the patient's elevated CK? Explain why the physician ordered a CK-MB and troponin level. What can you conclude about the patient's cardiac status? 2) What is the cause of his acute renal failure? 3) What is the significance of the patient"s large urine hemoglobin? 4) How would you interpret this patient's liver function tests considering his clinical history?
Case Study:
A 52 year-year old man with a history of AIDS, hypertension, diabetes mellitus, and alcohol abuse was found unconscious in his home by his roommate. In the emergency department, he was hypotensive (103/60 mm Hg), febrile (temperature 101F), and unresponsive. Computed tomoggraphy scan of the abdomen showed choleccystitis and gallstones. Laboratory data are listed.
The patient was diagnosed with acute renal failure. He was administered intravenous fluids; BUN fell to 68 mg/dL and creatinine fell to 2.2 mg/dL. The patients blood culture report was positive for e. coli. He was treated with tobramycin and cefepime. The patient continued to deteriorate and died 5 days after admission. Cause of death was multiorgan failure secondary to AIDS, sepsis, and alcoholic cirrhosis.
DATA TABLE
Drugs of Abuse Negative Urinalysis
Serum ethanol 84mg/dL Hemoglobin Positive
WBC 4 HPF (0-4)
RBC 2 HPF (0-4)
CK 3,308 U/L (24-204) BUN 71 mg/dL (8-21)
CK-MB 15 ng/ml (0-7.5) Creatinine 4.1 mg/dL (0.9-1.5)
Troponin T <0.01 ng/ml (0-0.4) Alkaline phosphatase 443 U/L (45-122)
pH 7.50 Aspartate aminotransferase 305 U/L (9-45)
pCO2 27 mm Hg Alanine aminotransferase 78 U/L (8-63)
Total CO2 15 mmo/L Gamma glutamyl transpeptidase 724 U/L (11-50)
Total bilirubin 2.7 mg/dL (0.2-1.0)
Direct bilirubin 2.4 mg/dL (0-0.2)
Questions:
1) What is the significance of the patient's elevated CK?
Explain why the physician ordered a CK-MB and troponin level. What can you conclude about the patient's cardiac status?
2) What is the cause of his acute renal failure?
3) What is the significance of the patient"s large urine hemoglobin?
4) How would you interpret this patient's liver function tests considering his clinical history?
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