nbme2.112

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nbme2.112

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sailing boat
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Topics: 54
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06/22/07 - 04:55 AM

ans plzzz

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sailing boat
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Topics: 54
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06/22/07 - 07:20 AM

anyone can tell this one plzz

doc-o8
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06/22/07 - 09:04 AM

its a difficult qs.. i have been thinking about it a lot of times. wts wrong with him. may be its SIADH after meningitis? plz if somebody knows try to answer this qs.more interested in diagnosis.

sandra
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07/17/07 - 07:20 AM

what does he have? UTI? he is clearly dehydrated. but he is wetting diapers(mebbe coz he is taking lot of fluids coz he is thirsty due to dehydration)..if he is taking fluids why should he be dehydrated? if its SIADH, urine output should be less isnt it?

what is this? plz some one explain

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dr_arc
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07/17/07 - 07:40 AM

hmmm, this sounds like fanconi syndrome, defect in proximal reabsorption of solutes glucose phospates and amino acids , therefore loss of solutes and accompanying water loss , hence the dehydration.
urine is dilute cos loss of conc ability, also hypokalemia and hyperchloremia.
that is all i can recall rt now.
can someone pls add more information

young_doc
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07/17/07 - 07:52 AM

This looks like neonatal sepsis to me: fever, lethargy + hemodynamic instability ?

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dr_arc
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07/17/07 - 08:04 AM

i think it is unlikely to be sepsis, no reason to suspect infection, plus the baby is constantly wet i.e polyuria, constantly thirsty = polydipsia, dehydrated =depressed ant fontanelle. i think itis fanconis

young_doc
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07/17/07 - 08:17 AM

How would you explain the fever? Also Fanconi's commonly presents with glycosuria and proteinuria which is negative in this case.

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dr_arc
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07/17/07 - 01:33 PM

hi young doc i searched and found this , i think it is def fanconis now. the reason that glycosuria has not shown up is probably they didnt want to give us so much information. let me know wha you think.

www.emedicine.com/ped/topic756.htm - 106k

young_doc
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07/17/07 - 02:41 PM

#10

Actually i looked at emedicine as well!! (i love emedicine)

Anywho, the last line of the question states that urine is (-) for glucose and protein...I think by giving us that much information, they're trying to hint at a cause OTHER than tubular-reabsorption defects...? confused

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dr_arc
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07/18/07 - 02:24 AM

#11

hey big oops! i didnt notice that. hope i dont do something like that on the real exam.
so now it is back to square one.
what else could it be?
the neonate has polyuria , polydipsia and is febrile and dehydrated? where does that picture fit in?
where do you see a dehydrated thirsty water losing neonate?
the polydipsia and polyuria makes me strongly think of some renal tubular pathology.
confused

dr_arc
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07/19/07 - 04:55 AM

#12

hellllloooooooo... people of the world out there. please can someone make sense of this question. it is killing me. sad

dr in trouble
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07/20/07 - 11:49 AM

#13

To me it is look like nephrogenic diabetes insipidus secondary to neonatal sepsis or meningitis.

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robin082006
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07/20/07 - 11:53 AM

#14

C

This is Diabetes insipidus

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dr_arc
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07/21/07 - 10:44 AM

#15

i guess that is the only one that fits the picture so i guess the answer could be C, but a serum Na of 163 sounds wy too high. i guess i had a mental block reagrding diagnosing DI in a child.
thanks guys, the fever i guess is die to the extreme dehydration
. the 163 is bothering me a bit. mad

Dinie

07/21/07 - 07:18 PM

#16

could this be CAH with salt wasting and answer ? b

dr_arc
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07/23/07 - 01:38 AM

#17

Dinie wrote:
could this be CAH with salt wasting and answer ? b

CAH with salt wasting sounds a little doubtful to me cos of the polyuria and polydipsia here, also i think the CAH pt presenting in the neonatal period will have a moe profounf hypotension and electrolyte imbalance. i think it must be diabetus insipidus.

rezaaa
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08/01/07 - 12:59 AM

#18

i knew it was DI but i didnt know whether the answer was C or D. its because i didnt understand specific gravity of urine very well. for those of you like me here is a short course on specific gravity of urine ! :

Urine Specific Gravity:
Specific gravity (which is directly proportional to urine osmolality which measures solute concentration) measures urine density, or the ability of the kidney to concentrate or dilute the urine over that of plasma.

Normal specific gravity range in urine
1.020 -1.030 g/ml

Reduced specific gravity:
diabetes insipidus
excess fluid intake
diabetes mellitus

Raised specific gravity:
dehydration
adrenal insufficiency
nephrosis
congestive cardiac-failure
liver disease

Constant specific gravity:
chronic renal disorder

ok it doesnt seem so difficult now.

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