End-Stage Kidney Disease
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, 2+ bilateral edema, and 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. Her
recent laboratory results are as follows:
CBC
Sodium 126 mEq/L
Glucose 220 mmol/L
Calcium 7.1 mg/dl
Red blood cell count 3.9 cells/ul
Vitals
Blood Pressure 92/64 mmHg
Blood Gases
pH 7.28
CO2 30 mmHg
HCO3 12 mmol/L
Hormone Panel
Renin Low
ADH Elevated
Aldosterone Low
Vitamins
Vit D Low
Vit K Low
Vit E Low
Vit A Low
Urine and Stool Sample
Stool color Gray
Stool content Increased Fat Content
Urine color White
Rev 12-17-17
Please address each of the following regarding Sarah’s case:
- Explain the cause for her low calcium and sodium levels.
- Explain the cause of her anemia. What laboratory test should indicate she is
suffering from anemia? - Explain the cause of her hypotension. How will her body attempt to establish
homeostasis? - What type of acid-base disorder has she developed, and how will her body
compensate? - Explain the cause of her elevated ADH and glucose levels.
- What is the correlation between her illnesses and the low vitamins (D, K, E, and
A), renin, and aldosterone levels? - Which hormone would the body elevate in response to her low calcium levels?
Why? - Explain the physiological reason behind her physical findings (yellowish hint of
the skin, sclera, multiple bruises, weakness, and edema). - Explain the cause of her abnormal stool and urine sample.
- What cell does Glisten work on? Explain how this medication is able to stimulate
insulin secretion.
Sample Solution