The most likely underlying cause of the findings in this patient is a defect in which of the following? a. angiotensin-converting enzyme b. aquaporin c. 11a-Hydroxylase d. renin e. vasopressin receptors
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A 3-month-old boy is brought to the emergency department because of a 20day history of lethargy. Physical examination shows no other abnormalities. The results of laboratory studies are shown:
serum:
Na+ 165 mEa/L (N=139-146)
Cl- 130 mEq/L (N=95-105)
Osmolality 334 mOsmol/kg H2O (N=282-295)
urine:
specific gravity 1.001
osmolality 117 mOsmol/kg H2O (N>200)
He is admitted to the hospital. His urine output is increased. His serum ADH (vasopressin) concentraion is 24 pg/mL (N=1-5); aldosterone and renin concentrations are within the reference ranges. The urine osmolality remains unchanges after administration of 1-deamino-B-arginine vasopressin. An MRI of the brain and pituitary gland shows no abnormalities. Ultrasonography shows normal kidneys. The most likely underlying cause of the findings in this patient is a defect in which of the following?
a. angiotensin-converting enzyme
b. aquaporin
c. 11a-Hydroxylase
d. renin
e. vasopressin receptors
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- Patient A is 65 years old female. She has been diagnosed with diabetes Type II. Recently she experienced a gastrointestinal illness with nausea and vomiting. Lab data have been obtained the following day after her illness: Body weight 85 kg; Blood pressure 140/90 mmHg; Blood pH – 7.48; PCO2 – 44 mm Hg; Plasma HCO3 ion -32 mEq/L; Urine pH – 7.5. What is acid-base disorder of this patient. What was a main cause of this? The illness continues and after 2 days the following laboratory data have been obtained: Body weight 83 kg; Blood pressure 120/70 mmHg; Blood pH – 7.50; PCO2 – 48 mm Hg; Plasma HCO3 ion -36 mEq/L; Urine pH – 6.0. Has acid-base disbalance been changed? If yes, what is the explanation for this acid-base disbalance? Is there any compensation?In reviewing the patient’s current information, a concern exists that acute kidney injury has developed. Select to highlight the laboratory information that would support this concern.UrinalysisCasts - +++Cola-color to urineProteinuriaBlood ValuesRBC - 3.9 cells/L (4.0-4.9 cells/L)Hgb 10 g/dL (12-16 g/dL)Hct-40% (37%-48%)WBC 11.0 cells/L (4.0-10.0 cells/L)Platelets - 140 cells/L (150-450 cells/L)Sodium - 140 mEq/L (135-145 mEq/L)Potassium - 4.5 mEq/L (3.5-5.2 mEq/L)BUN - 32 mg/dL (5-20 mg/dL)Creatinine 1.8 mg/dL (0.5-1.5 mg/dL)Blood Glucose - 180 mg/dL (nonfasting) (<200 mg/dL)AST-40 Units/mL (5-40 Units/mL)ALT - 30 Units/mL (5-35 Units/mL)Bilirubin (total)- 0.8 mg/dL (<1.0 mg/dL)Albumin - 4.0 (3.5-5.5 g/dL)PT-22 (11.5-14 seconds)Hematology Data: 24 hour urine volume: 1,000 mL; Serum Creatinine: 2.0 mg/dL; Urine Creatinine: 200 mg/dL What's the calculation for the Creatinine clearance? Please show steps, thank you!
- A 68-year old woman presents with hypertension and oliguria. A CT of the abdomen reveals a hypoplastic left kidney. based on the following laboratory data which of the following is her estimated RPF? Renal artery p-amino hippuric acid (PAH) = 6mg/dL Renal vein PAH = 0.6mg/dL urinary PAH = 25mg/mL urine flow= 1.5mL/min hematocrit = 40%pathophysiology Lisa Smith (LS) is brought to the emergency department [ER] for management of accidental acute poisoning. She is nonresponsive and admitted to the critical care unit [CCU] to be closely monitored. LS has no urinary output, and her laboratory values are serum K+ = 6.7 mEq/L; serum Na+ = 177 mEq/L; arterial blood gases [ABGs]: pH = 7.13, PaCO2 = 35 mmHg, HCO3- = 16 mEq/L, PaO2 = 89 mmHg, and oxygen saturation = 94%. Identify LS’s current acid-base disorder. What is the most likely underlying cause of the acid-base disorder LS is experiencing?Paul is a 23-year-old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. Paul’s vital signs and hematocrit suggest that he has had a blood loss of about 2,500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium. 1. What type of renal failure is Paul likely developing? What data support this conclusion?
- Paul is a 23-year-old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. Paul’s vital signs and hematocrit suggest that he has had a blood loss of about 2,500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium. In addition to urine output, what laboratory data should be monitored to assess changes in Paul’s renal function?Paul is a 23-year-old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. Paul’s vital signs and hematocrit suggest that he has had a blood loss of about 2,500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium. Discussion Questions1. What type of renal failure is Paul likely developing? What data support this conclusion?2. Without adequate therapy, what may develop? Why? What is the best therapy for preventing this from occurring?3. In addition to urine output, what laboratory data should be monitored to assess changes in Paul’s renal functionPaul is a 23-year-old. He was the victim of a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a concussion, and a deep laceration of his left thigh. He was discovered approximately 2 hours after the incident and is now in the emergency department. Paul’s vital signs and hematocrit suggest that he has had a blood loss of about 2,500 ml. A urinary catheter is inserted to monitor urine output, and fluid resuscitation is initiated while his wounds are cleaned and sutured. The urine output is averaging 15 ml/hr, with a high urine osmolality and low urine sodium. Without adequate therapy, what may develop? Why? What is the best therapy for preventing this from occurring?
- A woman found confused on the floor of her apartment is brought to the emergency room by her daughter. She complains of muscle weakness. Serum electrolytes were determined and shown below. Use this information to answer questions 13-16. Electrolyte Plasma Levels (Normal) ICF Conductance Na+ 138 mM (135-155 mM) 14 mM 1 K+ 2.9 mM (3.5-5.0 mM) 155 mM 7 Cl- 115 mM (110-120 mM) 20 mM 0 13. The equilibrium potential for Na+ in this patient will be at__________. A) 60 mV B) -60 mV C) 65 mV D) -70 mV 14. The equilibrium potential for K+ in this patient will be at__________. A) -70 mV B) -90 mV C) 104 mV D) -104 mV 15. The resting membrane potential in this patient will be at__________. A) 0 mV B) -70 mV C) -83 mV D) -104 mVA 2-year-old child, admitted to hospital following diarrhoea and vomiting, had the fol- lowing results on analysis of plasma, 24 hours after admission (reference ranges are given in brackets): Sodium (135-145) Potassium (3.5-5.0) Urea (3.5-6.6) Creatinine (70-150) Osmolality (285-305) The urine sodium concentration was 55 mmol/L and its osmolality was 314 mOsm/kg. Comment on these results. 151 mmol/L 3.7 mmol/L 4.9 mmol/L 65 μmol/L 314 mOsm/kgWhat is the patient's creatinine clearance given the following data? Serum creatinine 0.6 mg/dL Urine creatinine 102 mg/dL 24 hr urine volume 1650 mL Patient's BSA 1.93 m2 1) 195 mL/min 2) 130 mg/dL 3) 93 mL/min 4) 175 mL/min no references, just homework