Urinary Case Study #2 Clinical history A 60-year-old woman, known to have chronic glomerulonephritis, was regularly going to hemodialysis, until one day she decided to refuse this treatment and stay home. She was found unconscious and hospitalized. Clinical findings The woman was comatose. Her blood pressure was 190/120 mm Hg, and she appeared edematous. Fluid was evident in the pleural and pericardial spaces, and the pulse rate was fast. The skin had good turgor. Several ecchymoses were present on the extremities, and her gingivae were suffused with blood. Laboratory findings She had pronounced anemia, which was normocytic and normochromic. The leukocytes and platelet counts were normal. Serum electrolyte disturbances included hyperkalemia, hyperphosphatemia, hypocalcemia, and low bicarbonate. The pH of the blood was low. Urea and creatinine were markedly elevated. Follow-up She underwent emergency hemodialysis and recovered. Questions for you to answer: 1. Why is dialysis performed? How could one measure the efficiency of dialysis? 2. Why did this woman lose consciousness? 3. Why does she have hypertension? Is she dehydrated or does she show signs of water retention? Why does she have a bleeding tendency?
Urinary Case Study #2 Clinical history A 60-year-old woman, known to have chronic glomerulonephritis, was regularly going to hemodialysis, until one day she decided to refuse this treatment and stay home. She was found unconscious and hospitalized. Clinical findings The woman was comatose. Her blood pressure was 190/120 mm Hg, and she appeared edematous. Fluid was evident in the pleural and pericardial spaces, and the pulse rate was fast. The skin had good turgor. Several ecchymoses were present on the extremities, and her gingivae were suffused with blood. Laboratory findings She had pronounced anemia, which was normocytic and normochromic. The leukocytes and platelet counts were normal. Serum electrolyte disturbances included hyperkalemia, hyperphosphatemia, hypocalcemia, and low bicarbonate. The pH of the blood was low. Urea and creatinine were markedly elevated. Follow-up She underwent emergency hemodialysis and recovered. Questions for you to answer: 1. Why is dialysis performed? How could one measure the efficiency of dialysis? 2. Why did this woman lose consciousness? 3. Why does she have hypertension? Is she dehydrated or does she show signs of water retention? Why does she have a bleeding tendency?
Chapter25: Diuretics And Medications Used For Urinary System Disorders
Section: Chapter Questions
Problem 25RQ
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Urinary Case Study #2
Clinical history A 60-year-old woman,
known to have chronic glomerulonephritis,
was regularly going to hemodialysis, until
one day she decided to refuse this treatment
and stay home. She was found
unconscious and hospitalized.
-- -
-
Clinical findings The woman was
comatose. Her blood pressure was 190/120
mm Hg, and she appeared edematous.
Fluid was evident in the pleural and pericardial spaces, and the pulse rate was fast. The skin had
good turgor. Several ecchymoses were present on the extremities, and her gingivae were
suffused with blood.
Laboratory findings She had pronounced anemia, which was normocytic and normochromic.
The leukocytes and platelet counts were normal. Serum electrolyte disturbances included
hyperkalemia, hyperphosphatemia, hypocalcemia, and low bicarbonate. The pH of the blood
was low. Urea and creatinine were markedly elevated.
Follow-up She underwent emergency hemodialysis and recovered.
Questions for you to answer:
1. Why is dialysis performed? How could one measure the efficiency of dialysis?
2. Why did this woman lose consciousness?
3. Why does she have hypertension? Is she dehydrated or does she show signs of water
retention? Why does she have a bleeding tendency?
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surrused with blood.
Laboratory findings She had pronounced anemia, which was normocytic and normochromic.
The leukocytes and platelet counts were normal. Serum electrolyte disturbances included
hyperkalemia, hyperphosphatemia, hypocalcemia, and low bicarbonate. The pH of the blood
was low. Urea and creatinine were markedly elevated.
Follow-up She underwent emergency hemodialysis and recovered.
Questions for you to answer:
1. Why is dialysis performed? How could one measure the efficiency of dialysis?
2. Why did this woman lose consciousness?
3. Why does she have hypertension? Is she dehydrated or does she show signs of water
retention? Why does she have a bleeding tendency?
4. Why does this woman have anemia? How could this anemia be treated?
5. Interpret these laboratory findings. What are the possible consequences of hyperkalemia
and the other electrolyte disturbances?
6. What is the cause of acidosis?
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