robin082006
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8. A 16-year-old girl has generalized weakness and nocturnal leg cramps. She is not taking any medications. Laboratory studies show:<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
Serum
Na+ 135 mEq/L
Cl– 108 mEq/L
K+ 2.8 mEq/L
HCO3– 21 mEq/L
Urine pH 7.0
Which of the following is the most likely diagnosis?
A) Adrenal insufficiency
B) Hyporeninemic hypoaldosteronism
C) Nephrogenic diabetes insipidus
D) Renal tubular acidosis
E) Syndrome of inappropriate ADH (vasopressin
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| vanshita
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C
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| Cedrick
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check sodium
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| Cedrick
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A ?
I have seen this one before but I can find it man,I do know that it has to do with the low sodium
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| Cedrick
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A.-Adrenal insufficiency .-Addison Disease
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| guangyu
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B
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| Cedrick
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Prove it
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| reet
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D
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| Cedrick
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thanks reet I will search
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| Cedrick
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I did not see that ph !!! oh man
Thanks you reet,see that is why I post things
mistake corrected
D.-renal tubular acidosis
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| yasmeen
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:nod
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| drbcshah
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Look at na and bicarb values
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| study_ing
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any who knew y they'd chosen it, please explain...
K low rules out low aldosterone states..hence Addison's out as well as B
In DI, ionic [] wud not be low so that's out....
what abt the last two...y not SIADH??
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| robin082006
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I go with E
A) Adrenal insufficiency : excluded because lack of aldosterone results in hyperkalemia
B) Hyporeninemic hypoaldosteronism : excluded because lack of aldosterone results in hyperkalemia
C) Nephrogenic diabetes insipidus : will have hypokalemia and hyponatremia, high urine pH (too much water in urine causes decreased urinary H+ concentration therefore increased pH)--> excluded
D) Renal tubular acidosis : low urine pH causes loss of H+--> increased serum HCO3----> excluded
E) Syndrome of inappropriate ADH (vasopressin : cause hypokalemia, hyponatremia (in this case it is at lower reference), low urine pH(due to high urine concentration of H+), low serum HCO3-
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| study_ing
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thanx robin ..
my way of looking at things...seems a dilutional process as every ion seems less concentrated!!
siadh
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| Chrales
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CAREFUL:
Renal tubular acidosis is an ACIDOSIS due to different reasons:
I) inappropriate H+ Secretion (distal type)
II) HCO3-loss in the proximal tubulus (proximal type)
Thus the urine pH is going to rise.
There are also other reasons for renal tubular acidosis.
So, answer D is correct, since the SERUM pH is low
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| Chrales
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Here also a text passage:
Renal tubular acidosis (RTA) is a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a person's blood to remain too acidic. Without proper treatment, chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, and progressive renal failure.
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| vamsi2004
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whats the ans- D or E?
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| Dragonfly
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guys we have discussed this Q. before :
http://www.prep4usmle.com/forum/thread/35497
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| Cedrick
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D
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