West Coast University
Sarah, a 63-year-old female with a past medical history significant for diabetes mellitus, cirrhosis, gout, and a 30-pack a year smoking history, presents to the emergency room with chest pain revealing pericarditis in the echocardiogram, secondary to recently diagnosed end-stage renal disease. Physical examination reveals yellowish discoloration to the skin and sclera, multiple bruises, and 2+ bilateral edema. Sarah reports weakness lasting more than three weeks. Her medications include Glisten, a new drug for diabetes that causes ATP sensitive potassium channels to close, thereby releasing insulin.
1)Explain the cause for her low calcium and sodium levels:
Low blood Sodium levels (hyponatremia) in this case study may be because of the high levels of the anti-diuretic hormone, which makes the body retain water, as such the concentration of the sodium in the body will be reduced or low. Hyponatremia which is also named low sodium is brought about by a situation when the level of sodium in the blood is significantly low.
Sodium is an example of electrolyte needed in the body for daily activities it is essential in determining and regulating, the amount of water that’s in and around your cells. Hyponatremia, which is also known as low sodium as a result of dilution due to fluid retention. The fluid retention which clinical signs are edema is as a result of reduced kidney function. Antidiuretic hormone is found in the brain area called hypothalamus. This antidiuretic hormone is stored or kept and released or let out when needed by the pituitary gland is also called the master gland. The antidiuretic hormone is responsible for regulation and controlling the way the body uses and conserves or distribute water as well as hold on to water. When ADH also referred to as vasopressin is in excess, the condition is called syndrome of the inappropriate antidiuretic hormone.
Syndrome of inappropriate antidiuretic hormone, makes it challenging for the human body to allow release or let out water. Also, the hormone, causes levels of electrolytes, like sodium, potassium, and phosphorus to decrease due to water remaining in the body. Hyponatremia is a significant complication or problems of SIADH and is one of some of the symptoms of SIADH. Early symptoms may be mild and not too problematic, such as cramping, nausea, and vomiting ranging to severe cases of SIADH which signs can be manifested as confusion, seizures, and even coma.
Furthermore, the low calcium levels are due to low levels of calcitriol which is synthesized by the kidneys. The result of decreased or low calcium levels in the blood is due to the low levels of vitamin D. Vitamin D helps functions in the absorption of Calcium from the intestines or gut.
2)Explain the cause of her anemia. What laboratory test should indicate she is suffering from anemia?
The cause of anemia is most likely due to the renal disease which in this case is end-stage renal disease or kidney failure. Anemia is one of the complications of end-stage renal disease as anemia is often observed with patients with kidney failure. Kidneys enable the release of the hormone erythropoietin. Erythropoietin empowers the bone marrow to produce red blood cells. In a case of end-stage kidney disease, such as the patient in this case study, the erythropoietin levels are decreased which leads to the anemia. Also, when the person shows signs of liver failure which clinical presentation or signs are yellow of the skin and sclera it may be concluded that the patient has hemolytic anemia. (Albert, 2013)
There are many laboratory tests for assessing the anemia- the most popular laboratory test for indicating the anemic condition of this lady is the red blood cell (RBC) count which is less. The normal level is 4.2 to 5.4 million cells/ul(Albert, 2013). Complete blood count can also be used to detect anemia as well as, Iron level- serum iron levels, if serum iron is low then there will be anemia, another test like Vitamin B12, Liver and kidney function tests, folate level as well as Bone marrow biopsy can be used to detect other kinds of anemia in a patient,
3. Explain the cause of her hypotension. How will her body attempt to establish homeostasis?
Hypotension is low blood pressure which can be caused by different abnormalities in the body. In this case study, the increased water retention in the body stops the release of hormone renin from kidneys. The hormone renin activates the inactive hormone angiotensinogen to angiotensin I, and then it is converted to angiotensin II which is a vasoconstrictor. As the hormone renin is inhibited by high levels of the Antidiuretic hormone, the blood pressure will reduce which leads to hypotension. The blood pressure is regulated by the hormone angiotensin II, a vasoconstrictor and When it is released, the blood pressure increases. In the given case, the patient has elevated levels of ADH is inhibited by elevated levels of ADH, the blood pressure reduces which leads to hypotension. Furthermore, when the body tries to establish and maintain homeostasis, the level of renin would be increased or elevated and release angiotensin II, which is known as a vasoconstrictor.
4). What type of acid-base disorder has she developed, and how will her body compensate?
Specific lab values are to be considered when discussing acid-base disorder, PH levels, bicarbonate ions, carbon dioxide as well as oxygen level are essential. The normal ph levels are 7.35 -7.45, bicarbonate (HCO3) normal levels are 22-26mmol/L. In this case study, The HCO3 is low 12mmol/L which is one of the markers for the disorder of metabolic acidosis PH level is not in normal range, which is 7.28. This may be due to the reduced concentration of bicarbonate ions in the body.
The compensation or to bring improve this metabolic acidosis is the initiate the increased in the absorption of bicarbonate ions (HCO3) in the kidneys. There is a respiratory compensation for metabolic acidosis.It can be compensated or normalized by decreasing the partial pressure of (Co2)
5) Explain the cause of her elevated ADH and glucose levels.
Elevated ADH may be caused by the disease known as SIADH which is the syndrome of inappropriate ADH. Furthermore, the presence of lung carcinoma can also account for the elevated ADH; the patient shows a history of smoking. There is a history of diabetes mellitus so that glucose levels will be increased due to insulin deficiency. The glucose level is elevated due to the patient’s response to insulin and glucose utilization is impaired. Antidiuretic hormone is elevated because of the dilution. In diabetes mellitus, the flow of urine is increased, as such fluid movement in the body is accelerated because of the glucose- triggered or induced an osmotic diuresis or water loss. (Calhoun, 2017) On the other hand, plasma vasopressin (VP) is elevated in both type 1 and type 2 DM. This elevation seems to be due to a resetting of the osmostat. A high VP level is beneficial in the short term because it limits to some extent the amount of water required for the excretion of a markedly enhanced load of osmoles (mainly glucose). However, in the long run, it may have adverse effects by favoring the development of diabetic nephropathy.
6) What is the correlation between her illnesses and the low vitamins (D, K, E, and A), renin, and aldosterone levels?
Low levels of renin results in hypotension. Renin plays a vital role in activation of angiotensinogen to angiotensin II, a vasoconstrictor which is needed for maintenance of blood pressure. As a result of reduced or low levels of renin, she has hypotension. (Calhoun, 2017)
The hormone aldosterone triggers the kidneys to reabsorb sodium. Low levels of aldosterone results in a reduced level of sodium (hyponatremia) in the body.
The elevated levels of ADH result in high rate of retention of water which occurs in low sodium level in blood. This is responsible for bilateral edema.
The patient’s physical assessment reveals that she has skin discoloration possible jaundice, yellowish sclera, and multiple bruises. This is as a result of the deficiency of or low vitamin A. Furthermore; the patient lab values shows hypocalcemia; this may be as a result of lack of vitamin D as earlier discussed which is useful and vital in the absorption of calcium from the intestine. (Albert, 2013) Low levels of calcium can also be associated with Vitamin K deficiency also because of blood clotting factor functions based on the calcium level in the body.
The patient’s weakness may be associated with vitamin E deficiency. The absence of vitamin E can be problematic to the body as it is an excellent and vital antioxidant needed in the body
7) Which hormone would the body elevate in response to her low calcium levels? Why
There is a low level of calcium in the body. The level of calcium can be regulated and controlled by parathyroid hormone (PTH) (Calhoun, 2017). This hormone helps in decalcification of bones that triggers the release of calcium into blood, t as such increasing reabsorption of calcium in the kidneys. The parathyroid hormone will be elevated or high in response to low calcium levels. This is because parathyroid hormone increases phosphate excretion and increases serum calcium by increasing renal calcium reabsorption. (Silverthorn, 2019)
8) Explain the physiological reason behind her physical findings (yellowish of the skin, sclera, multiple bruises, weakness, and edema).
Jaundice is referred to as discoloration of the skin; it presents itself as yellowish skin, mucous membrane, and sclera. Resulting from high or increased levels of bilirubin in the blood.
Yellowish discoloration of skin, sclera – it is suggestive of icterus. Icterus is a condition caused by hyperbilirubinemia. The presence of this suggests liver pathology.
Skin bruises – this may be due to Vitamin A deficiency or inadequacy as Vitamin A helps in maintaining the integrity of the skin. (Silverthorn, 2019)
Weakness could be as a result of anemia. Weakness is one of the significant symptoms of weakness, and also weakness could be a result of low levels or decreased Vitamin E.
Edema – Aldosterone, and renin play a significant role in edema. Edema is most of the time caused by excessive retention of salt and water in the body. Increased ADH and decreased levels of Renin and Aldosterone can affect the body and cause it to swell
9) Explain the cause of her abnormal stool and urine sample.
There is insufficient excretion of the bilirubin from the liver, due to some obstruction. Due to the inadequate excretion colors of our excreted waste products can change in color. The regular brown color of stool is due to an excretory product of bilirubin, called stercobilin, which is metabolized from bilirubin.
The fat in the stool may also be due to the bile obstruction or gallbladder malfunction. The regular yellow color of urine is as a result of the urobilinogen, which is also an excretory product of bilirubin, as the bilirubin excretion is decreased, the color of output will change. (Silverthorn, 2019)
10) What cell does Glisten work on? Explain how this medication can stimulate insulin secretion
Glisten work on the beta cells of the pancreas. Beta cells secrete insulin which increases glucose metabolism while alpha cells release glucagon. The secretion of insulin is an ionic and electrical event in the membrane. Of the beta cell. If there i no glucose, membrane potential remains stable (-65mV). ATP from the glucose metabolism blocks or closes the K+ ion channels in the membrane. Therefore, more the glucose, more will be the closure of K+ ion channels.
The decreased permeability of K+ ions in the cell will cause depolarization and opening of voltage-gated Ca2+ ion channel opening.
Glisten also function by closing the ATP dependent K+ion channels to close, as such inducing the release or let out of insulin from the beta cells.
Silverthorn, D. U. (2019). Human physiology: An integrated approach (8th edition). Integrated Physiology II: Fluid and Electrolyte Balance pp. 641-642. United States of America. Pearson Education, Inc.
Smith, J. (2016, April 03). Bones, Calcium, Phosphate, and PTH in Kidney Failure – High and Low Calcium Causes, Effects and Treatment. Retrieved from https://www.kidney.org.uk/help-and-info/medical-information-from-the-nkf-/medical-info-calcium-phosphate-index/medical-info-calcium-phosphate-levels/
Calhoun, R. (2017, August 24). Antidiuretic Hormone (ADH) Test: Definition and Patient Education. Retrieved from https://www.healthline.com/health/adh
Antidiuretic. (n.d.). Retrieved from https://www.sciencedirect.com/topics/medicine-and-dentistry/antidiuretic