Case study – Chemistry 2 Julia Dugger 09/08/2015 A 54 year old female was presented with complaints of lethargy, excessive thirst and diminished appetite. Given the fact that these symptoms are very broad and could be the underlying cause of various diseases, the physician decided to order a urinalysis by cystoscope; a comprehensive diagnostic chemistry panel; and a CBC with differential, to acquire a better understanding on his patient health status. The following abnormal results caught the physician’s attention: a) Urinalysis with significantly increased amounts of blood (via dipstick and sediment), protein, and leukocytes as well as slightly increased bilirubin and slightly decreased pH; b) Comprehensive diagnostic chemistry panel with significantly increased amylase (1626 with normal being 300-1100 U/L), total …show more content…
Since most patients will either have an intact immunoglobulin or a free light chain, quantifying the amount of the M protein will aid in calculating the myeloma tumor burden; staging the myeloma patients; and documenting their response to treatment (Dispenzieri, Lacy, & Greipp, 2004). Moreover, since in 93% of patients a monoclonal protein can be detected in serum and in roughly 70% a monoclonal protein or fragment will be present in urine, according to Nau and Lewis (2008), the diagnosis of an asymptomatic (smoldering) multiple myeloma disease depends on the presence of serum M protein levels of ≥ 3 g/dL; ≥ 10% of bone marrow plasma cells; no related organ or tissue destruction like bone lesions; and no symptoms. On the other hand, the diagnosis of a symptomatic multiple myeloma disease can be accomplished by the presence of M protein in serum and/or urine together with clonal bone marrow plasma cells or plasmacytoma; myeloma-related organ or tissue impairment; and obvious symptoms (Nau, & Lewis,
P3 – Describe the investigations that are carried out to enable the diagnosis of these physiological disorders
Kayla is a 24yo, G3 P1011, who was seen for a follow-up ultrasound assessment. The patient has chronic HTN but has not been on any medication. She has had some borderline elevated BP’s over the past couple of weeks. Her BP today when she arrived was 143/81 and 5 minutes later was 137/86. Her urine evaluation is negative for protein. She did have labwork performed revealing a creatinine of .58, uric acid of 6.2, with normal liver enzymes and a platelet count of 232,000. Her 24-hr urine was also normal at 200.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
The patient is a 75-year-old female who is brought to the ER because of some dizziness. She has a very complicated medical history of mitral valve prolapse, uterine fibromas having hysterectomy, a question of Ménière's disease, anxiety, hypertension, asthma, CVA in 1994 with mild right-sided residual weakness, urethral stenosis, recurrent UTIs, pulmonary embolism, and idiopathic afib she did presyncopal developed Equinox, a history of diverticulosis, and diverticulitis. The patient is admitted inpatient. It is to be noted initially there is a question of a syncopal episode. Troponins are negative. She is dehydrated with urinary specific gravity of 10:30, and she has positive nitrates and leukocytes. She was initially placed in the emergency
Related to Mr.X’s history of stage 5 CKD, abnormal calcium and phosphate levels will be contrary to each other. Patients with a history of renal failure with a high phosphate level may exhibit signs of hypocalcemia, such as the Trousseau or Chvostek’s sign.
The patient will commonly present with multiple symptoms, the most common are the 3 P’s – polyuria, polydipsia, and polyphagia. However, subjective symptoms may include reports of fatigue, abdominal pain, nocturnal enuresis, weight loss, changes in mood, and blurred vision. Objectively the signs will be hyperglycemia, confirmation of weight loss, abnormal lab values such as an elevated hemoglobin A1c (HbA1c) level, and abnormal urine results.
Ordered reviewed and interpreted laboratory data and other diagnostic studies to assess the patient's clinical problems and health care needs.
...A as means of precaution and confirmation whether the pancreas are performing in standard conditions. Also, the following tests are ordered to conclude if pancreatic enzyme supplementation is required.
If the patient has a urinary catheter, and most ICU patients do, he or she may not have any reportable symptoms. Therefore, good assessment of urinary elimination, done in relation to a patient’s signs, symptoms, urine amount, intake and output, and lab values, is important. The lab values are discussed in Chapter 5. Acute and chronic renal failure can cause numerous systemic symptoms and altered homeostasis ( Collins, 2011). See Table 3-10 for abnormal urinary elimination.
In 1984, Caeser Milstein of England and George Kohler of Switzerland were awarded Nobel Prize for engineering ‘monoclonal antibodies’. These are made outside the body by the fusion of B-cell and myeloma cells (cancerous cells). These hybrid cells are known as hybridomas.
As mentioned above; Hypoalbuminaemia is a predominantly events that occur due to losses of protein urinary. In response to this, hepatic albumin synthesis increased but they are still insufficient to prevent the fall in the serum albumin concentration. Proteinuria, Nephrotic range proteinuria is almost invariably due to glomerular disease.
There are no specific symptoms to detect multiple myeloma early. While symptoms may be present, they are often ve...
Rationale: These laboratory test results have been shown to be fair indicators of malnutrition. Ackley and Ladwig p. 576
weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is