CASE STUDY 27.1 A52-year-old man with a history of AIDS, hypertension, iabetes mellitus, and alcohol abuse was found uncon- scious in his home by his roommate. In the emergency department, he was (temperature 101°F), and unresponsive. Computed tomog- raphy scan of the abdomen showed cholecystitis and gallstones. Laboratory data are listed. The patient was was administered intravenous fluids; BUN fell to 68 mg/dL and creatinine fell to 2.2 mg/dL.The patient’s blood culture report was positive for E. coli. He was treated with tobra- mycin and cefepime. The patient continued to deteriorate hypotensive (103/60 mm Hg), febrile diagnosed with acute renal failure. He
and died 5 days after admission. Cause of death was multiorgan failure secondary to AIDS, sepsis, and alcoholic cirrhosis. 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? (continues on page 568)
ssessment of Organ System Functions CASE STUDY 27.1 (continued) Drugs of Abuse Negative Urinalysis Serum ethanol 84 mg/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) Creatinine CK-MB 15 ng/mL (0-7.5) 4.1 mg/dL (0.9-1.5) <0.01 ng/mL (0-0.4) Alkaline phosphatase Troponin T 443 U/L (45-122) Aspartate aminotransferase 7.50 305 U/L (9-45) pH Alanine aminotransferase 78 U/L (8-63) 27 mm Hg pCO Gamma glutamyl transpeptidase 724 U/L (11-50) Total CO 15 mmol/L 2.7 mg/dL (0.2-1.0) Total bilirubin 2.4 mg/dL (0-0.2) Direct bilirubin
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