siresuelve
Forum Newbie
Topics: 1
Posts: 2
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Dear members which is your answer?
I have the Key of the answer but I do not agree with it
Could you please check this question , and explain your answer?
Regards
siresuelve
the question is below
if you do not want to see the question stop rigth now
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. . . . . . see below.......
Question #19.
Hospital discharge of a 75-year-old man is delayed due to unavailability of a bed in a
nursing home. He is bedridden and unable to attend to his personal needs. During a 3-day
period, his pulse increases from 82/min to 125/min, and blood pressure decreases from
124/72 mm Hg to 100/55 mm Hg. Laboratory
values include:
------------------------------- Day 1----------------------Day 3
Hemoglobin- --------------16.4 g/dL-----------------18.4 g/dL
Serum Urea nitrogen----- 18 mg/dL-----------------56 mg/dL
Glucose-------------------100 mg/dL ----------------89 mg/dL
Na+-----------------------135 mEq/L----------------151 mEq/L
Creatinine-------------------1.1 mg/dL----------------1.2 mg/dL
Which of the following is the most likely diagnosis?
(A) Acute renal failure
(B) Dehydration
(C) Diabetic ketoacidosis
(D) Gastrointestinal hemorrhage
(E) Syndrome of inappropriate ADH (vasopressin)
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| me007
Forum Guru
Topics: 72
Posts: 799
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prerenal asotemia - BUN/creatinine ratio >15/1
MCC ischemic ATN.
Can be dehydration as well.
B might be the better answer. - Hb increases, and they emphasise that hee is unable to attend his personal needs.
and BP is not too low for ARF
Edited by me007 on 01/14/07 - 12:22 PM
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| Ancylostoma
Forum Guru
Topics: 42
Posts: 636
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I absolutely agree with me007 . A true goljaner. this is prerenal azotemia caused by underperfusion of the kidney. It cannot be acute renal failure as the bun creatinine ratio would be 10:1 ratio still. Only two things that can cause this is gastrointestinal hemorrhage and dehydration. there is no reason to pick gastrointestinal hemmorhage and he is bedridden and unable to take care of his needs. It has to be dehydration.
B
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| siresuelve
Forum Newbie
Topics: 1
Posts: 2
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Dear ancylostoma
Ancylostoma wrote: “it cannot be acute renal failure as the bun creatine ratio would be 10:1 ratio still”
if you see day 3 BUN is 56 and creatine is 1.2 , then 56/1.2 = 46.6
in acute renal failure the ratio 10:1 or 15: 1 or 20:1 is LOST as in the question I posted above
The “official” answer is dehydration but WHY? If the ratio is lost in the third day
if the ratio is lost it means the kidney is not working
for me there are two answers dehydration and ARF
It is an acute renal failure caused by dehydration for that reason you have the increased pulse and low blood pressure
any comments?
Regards
siresuelve
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| babydoc4usmle
Forum Guru
Topics: 18
Posts: 631
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given that Cr is not changed (very little) and still in normal range = N GFR
decrease in BP + incr in HR = loss in volume
inc Na + loss volume = dehydration
this just my 2 cents
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