Case discussion

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Case Discussion
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CASE 1

• A 12 year old boy is brought to the Emergency
  Medical Services with nausea, vomiting, abdominal
  pain and breathlessness. On examination, he has
  hypotension and a fruity odour. His laboratory
  profile is as follows
• Plasma or serum results
• Glucose - 500 mg/dl(110-140 mg/dl)
• Arterial blood pH - 7.07 (7.357.45)
• PCO2 - 37 (3245 mm Hg)

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• Bicarbonate - 16 mmol/l (2230 mmol/l)
• Na - 136 mmol/l (136146 mmol/l)
• Potassium - 5.5 mmol/l (3.55.0 mmol/l)
• Urine
• Glucose
• Ketone bodies

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• Interpret the laboratory report.
• What is the most probable diagnosis?
• Why are potassium levels altered in this
  condition?
• State the criteria for diagnosing diabetes
  mellitus.

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CASE 2

• A 50 year old man was admitted in the hospital
  with complaints of loss of appetite and itching.
  Following are the findings
• Blood examination
• Total bilirubin 14 mg/dl (0.8 1.2 mg/dl)
• Direct bilirubin 13.2 mg/dl (0-0.2mg/dl)
• AST 40 IU/L (5-40 IU/L)
• ALT 30 IU/L (5-45 IU/L)
• Alkaline phosphatase 423 IU/L (80-120 IU/L)

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• Urine examination
• Bile salts
• Bile pigments
• Urobilinogen Nil
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• Mention the type of jaundice that the patient is
  suffering from.
• Why is urobilinogen absent in urine in this
  condition?
• Explain the cause of the itching in this patient.
  
• List two other enzymes which you can estimate in
  serum to confirm your diagnosis?
• Name any two clinical conditions that can lead to
  this type of jaundice.

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CASE 3

• A patient was operated for intestinal
  obstruction. He had
• continuous gastric aspiration for past 3 days.
  His arterial blood
• gas results are as follows
• pH 7.54 (7.35 7.45)
• pCO2 45 mm of Hg (35-45 mm of Hg )
• Plasma Bicarbonate 36mmol/L (22 - 26
  mmol/L)
• Serum Sodium 140 mmol/L (136-145 mmol/L)
• Serum Potassium 3 mmol/L (3.5 5 mmol/L)
• Serum Chloride 92mmol/L (96-106 mmol/L)

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• Interpret the laboratory profile. What is the
  most probable diagnosis?
• Calculate the anion gap. Interpret.
• Why is the estimation of urinary chloride
  important in this patient?

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CASE 4

• A female infant developed jaundice from the
• 3rd day of birth. On examination it was seen
• that she had increased muscle tone and
• bilateral cataract. On the 11th day, the child
• began vomiting and had convulsions. She had
• an enlarged liver. Her laboratory findings are
• as follows
• Random blood sugar 32 mg/dl
• Urine Benedicts test

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1. What is the probable diagnosis?
2. What is the biochemical defect in this condition?
   
3. What is the reason for bilateral cataract in this
   baby?
4. What is the reason for hypoglycemia in this
   patient?
5. What dietary advice is to be given to the patient?

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CASE 5

• A 56 yr old male subject had following
  biochemical report
• Serum cholesterol 375 mg/dl
• Serum HDL-cholesterol 25 mg/dl
• Serum Triacylglycerol 250 mg/dl

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• Calculate his LDL-cholesterol level. Name the
  formula used to calculate LDL-cholesterol levels.
  
• Name two tests for detection of cholesterol.
• Name any two drugs used therapeutically to lower
  the cholesterol levels.
• Name a water soluble vitamin which is used to
  lower cholesterol levels.

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CASE 6

• An obese 64-year-old male presented with severe
  pain in his right big toe. He gives a history of
  alcohol intake prior to the onset of the
  symptoms. On examination, his toe is found to be
  red and markedly swollen. His lab profile is as
  follows
• Glucose 103 mg/dL
• Urea 38 mg/dL
• Creatinine 1.2 mg/dL
• Uric acid 8 mg/dl
• Sodium 139 mmol/l
• Potassium 4.2 mmol/l

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• What is the probable diagnosis?
• What is the reason for its clinical
  manifestations?
• What diet should be advised to the patient ?
• Which drug can be used prophylactically in this
  condition? State its mechanism of action.

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CASE 8

• A 25 yr old female patient presented with history
  of palpitations and loss of weight. Her
• thyroid function report is given below
• Serum TSH 0.01 ?U/ml (0.6-5.0 ?U/ml)
• Serum total T4 18 ?gm/ml (5-12 ?gm/ml)
• Serum total T3 282 ng/dl (80-220 ng/dl)

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• What type of thyroid abnormality is seen in this
  patient?
• Why is free T4 a more reliable parameter for
  thyroid function than total T4?
• Name any two techniques that can be used to assay
  thyroid hormone levels
• Name the hormone used for screening of thyroid
  disorders.
• Mention any two common conditions that could
  contribute to the above biochemical
• abnormality.

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CASE 9

• A 6yr old boy presented with generalized edema.
• Following are the findings
• Serum total protein 4.9 g/dl
• Serum albumin 1.5 g/dl
• Serum urea 24mg/dl
• Serum creatinine 0.6 mg/dl
• Serum cholesterol 350 mg/dl
• Urinary protein 4.8 g/24hr

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• Which of the above parameters are showing
  abnormal result? (6)
• What is the most probable diagnosis? (2)
• Why is this condition associated with edema? (2)

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CASE 10

• A 60 year old diabetic man with uncontrolled
• diabetic status presents with generalized
• edema. His lab report is as follows
• Serum urea 150 mg/dl (20-40 mg/dL)
• Serum creatinine 4.0 mg/dl (0.8-1.2 mg/dL)
• Estimated GFR 45 ml/min

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• What is the most probable diagnosis?
• Name two more serum parameters useful for the
  confirmation of diagnosis
• What is the normal range of GFR? Name any three
  substances used in estimation of GFR in clinical
  practice

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CASE 11

• A 20 year old female has a plasma creatinine
  concentration of 0.1 mg/dl and in 1 hour excretes
  60ml of urine with a creatinine concentration of
  10.5 mg/dl.
• Calculate the creatinine clearance and comment on
  the result.
• What is the usefulness of estimating creatinine
  clearance in clinical practice?
• Why is creatinine clearance considered superior
  to urea clearance?

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CASE 12

• A newborn developed yellowish discoloration of
  the skin on Day 1. The blood chemistry report of
  the newborn is as follows
• Blood examination
• Serum total bilirubin------14 mg/dl
• Serum conjugated bilirubin------0.2 mg/dl
• Serum unconjugated bilirubin----13.8 mg/dl

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• Mention the type of jaundice that the newborn is
  suffering from?
• Name two causes of this type of jaundice.
• What would be the result from Vandenberg test
  in this case?
• What happens to urine urobilinogen levels in this
  condition?