ling
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A 62-year-old man with a 20-year history of alcoholism is admitted to the hospital for treatment of alcoholic hepatitis. He appears disheveled and malnourished. He is 198 cm (6 ft 6 in) tall and weighs 70 kg (155 lb); BMI is 18 kg/m2. Examination shows jaundice and temporal wasting. Scattered rhonchi are heard throughout all lung fields. Cardiac examination shows no abnormalities. Bowel sounds are normal. The liver span is 16 cm. Sensation to pinprick and light touch is decreased over the feet. Deep tendon reflexes are decreased at the ankles. Laboratory studies show:
Hematocrit 33%
Platelet count 145,000/mm3
Serum
Na+ 131 mEq/L
Cl– 92 mEq/L
K+ 3.1 mEq/L
HCO3– 26 mEq/L
Mg2+ 0.8 mEq/L
Ca2+ 5.8 mg/dL
Urea nitrogen (BUN) 6 mg/dL
Creatinine 0.8 mg/dL
Test of the stool for occult blood is positive. Which of the following is the most likely mechanism of this patient's hypocalcemia?
A ) Chronic metabolic acidosis
B ) Hypomagnesemia
C ) Impaired hydroxylation of vitamin D
D ) Primary hyperparathyroidism
E ) Renal resistance to parathyroid hormone
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| Aashi
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C ) Impaired hydroxylation of vitamin D
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| muna
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B?
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| neuroblastoma
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C ) Impaired hydroxylation of vitamin D
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| robin082006
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C ) Impaired hydroxylation of vitamin D
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| dr_jojo
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Mg2+ 0.8 mEq/L
Why not B
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| monterusca2004
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Why do you think that the answer here is impaired Hydroxilation of vit D?
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| maiya
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i'm not understanding why you guys have chosen hydroxylation of vit. d (please explain)
...i was actually thinking that this was a case of alcoholic neuropathy, and as such, there would be chronic metabolic acidosis in this alcoholic...and that led to both hyponatremia and hypokalemia. (Hypomagnesemia may be caused by poor nutrition?).
i may be TOTALLY wrong. please explain your answers...thanks!
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| ashfaque
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C , 25 hydroxylation of vit D takes place in liver so dec activation of vit D dec Ca levels
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| hanialkhadher
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This poor man has a prb with low calcium , low potasium, and guess what?LOW MAGNESIUM which is common in alcoholics and can explain BOTH.
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