cirus
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14) A 49-year-old man with a long history of alcohol abuse is brought to the physician by his wife because of gradually increasing confusion. He had been working as an apartment building superintendent until approximately 2 weeks ago, when he began feeling drowsy throughout the day and had difficulty sleeping at night. Since then, he has become confused and occasionally disoriented as to time and day. He can recognize his wife and neighbors, but cannot maintain casual conversations. He denies any fever, chills, or abdominal pain. Six months ago, he was admitted to the hospital with an upper gastrointestinal bleed, which was due to bleeding esophageal varices. His medications include ranitidine, spironolactone, furosemide, and propranolol. On physical examination, he is lethargic and disheveled. His temperature is 36.9 C (98.4 F), blood pressure is 112/64 mm Hg, pulse is 62/min, and respirations are 18/min. He has mildly icteric sclera and bitemporal wasting. His oral mucous membranes are dry. There is no jugulovenous distension. His lungs are clear, and he has a regular heart rhythm. His abdomen reveals a firm liver edge with a liver span of 7 cm in the midclavicular line. There is no shifting dullness, and a spleen tip is not palpable. He has no peripheral edema. On a mental status examination he recognizes the physician but cannot name the date, the reason for his visit, or his home address. Neurologic examination is nonfocal, and asterixis is present. Which of the following laboratory abnormalities will most likely be found?
A. BUN of 53 mg/dL
B. Glucose of 192 mg/dL
C. Potassium of 5.7 mEq/L
D. Serum bicarbonate of 16 mEq/L
E. Serum calcium of 14.2 mEq/L
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| treblechar
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A?
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| khorshid
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B? (I think it should not be A, because the main problem is that ammonia can't convert to urea, due to liver failure)
I'm not sure about E either
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| lakshya_0_7
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liver failure...hyperglycemia....B?
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| cirus
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treblechar, ur right the ans is A
the explanation is that the pt has liver ds, & is suffering from encephalopathy, they say that for encephalopathy to occur there hast to be a stressor, & usually its infec, but here since there is no infec, & the pt is on DIURETICS, the most probable cause is dehydration which will manifest by increased BUN!!
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| Justice
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Well, I answered A. BUN of 53 mg/dL before I read the explanation by Cirus, but I had no idea the pathogenesis would be so complex and linked to diuretics...
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| dr in trouble
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yes--comlex qs
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