Lim
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A demented elderly man is transferred from a nursing home to the emergency department because of generalized edema. The patient is afebrile, and his blood pressure is within normal limits. Blood samples are sent to the laboratory for analysis, yielding a serum creatine of 2.0mg/dL and serum urea nitrogen of 65 mg/dL. Which of the following is the most likely diagnosis?
A. Acute tubula necrosis.
B. Congestive heart failure.
C. Low protein intake.
D. Prostatic hyperplasia.
E. Severe liver disease.
what do you think?
Edited by Lim on 08/31/06 - 08:36 PM
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| docsrinu
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high bun/creatinine ratio in pre renal and post renal conditions. i think B (prerenal).
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| icemaiden
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D
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| Lim
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it's D.
can you explain why you chose it?
CHF,Prostatic hyperplasia both has increased BUN/Cr ration.
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| muzammil
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the choices of a c and e can be ruled out. my first choice was b. but i think as the blood pressure of the patient is normal so we may think agianst CHF.
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| Lim
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muzammil,thanks.that makes sense.
in acute heart failure, there could be (severe) hypotension.patient comes to ER because of general edema.it's an acute sxs.
so to be a CHF, there should be hypotension.
but if it's not a ER situaion,that could be both,i guess.
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| docsrinu
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ur right muzammil. also i think in CHF, creatinine is not constant where as in BPH there is an increase in creatinine. so the ans is D.
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| docsrinu
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sorry in CHF creatinin is constant (typo in my above post)
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| Lim
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thanks,docsrinu
do you conclude an ongoing increasing of serum urea nitrogen because it's 65 mg/dL.(i mean it's too high?) they did only one time blood sample analysis.
in case of acute CHF,there could be 65 mg/dL. what do you think?
hm...
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| oldkidontheblock
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why not E?
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| Lim
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oldkidontheblock
the patient has a problem with his kidney. at least related with it.
in severe liver disease(severe hypoproteinemia), there could be general edema,which get the patient run to ER emergently.but i guess severe liver disease is not directly linked with prerenal azotemia.
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| icemaiden
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in severe liver disease ----urea cycle cant happen, so BUN must decrease
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| Lim
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wow excellent. i didn't link those two facts. thanks icemaiden. i look up a book and i type below.
*BUN/Cr decrease
1. Urea systhesis decrease
Low protein diet
Starvation
Liver disease
2. Creatine synthesis increase
Rhabdomyolysis
severe seizure
3. Volume expansion
SIADH
iatrogenic
4.CRF with dialysis
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