doc649
Forum Junior
Topics: 18
Posts: 61
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A 65-year-old man with chronic obstructive
pulmonary disease requiring home oxygen at
night and cor pulmonale presents to the emergency
department (ED) with worsening shortness
of breath. On examination, the man’s respiratory
rate is 22/min and he has a heart rate
of 104/min. He has distant breath sounds and
is using accessory muscles of breathing. In addition
to his baseline chronic respiratory acidosis,
the man is found to have a metabolic acidosis
on arterial blood gas analysis. Laboratory
tests show:
Na+ 138 mEq/L
K+ 3.6 mEq/L
Cl− 118 mmol/L
HCO3
− 16 mEq/L
Phosphate 2.0 mg/dL
Glucose 98 mg/dL
Blood urea nitrogen 10 mg/dL
Creatinine 0.8 mg/dL
Urinalysis is positive for glucose. Which of the
following diagnoses explains this patient’s laboratory
findings?
(A) Right heart failure
(B) Steroid-induced glucosuria
(C) Type I renal tubular acidosis
(D) Type II renal tubular acidosis
(E) Type IV renal tubular acidosis
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| Eagle_303
Forum Senior
Topics: 18
Posts: 195
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Are you sure that Lab values are correct ?
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| hero
Forum Elite
Topics: 37
Posts: 460
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D
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| yarab99
Forum Elite
Topics: 15
Posts: 260
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D- type II RTA
the pt has normal anion gap metabolic acidosis,,,which suggest a diagnosis of RTA...in type II the problem is in the proximal tubule,,,so defect in the reabsorbtion of all the substanses absorbed there including GLUCOSE,,,so it is associated with glucosuria,,phosphaturia.( as in this Pt )
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| doc649
Forum Junior
Topics: 18
Posts: 61
|
The correct answer is D. The clinical scenario
is consistent with a generalized proximal
renal tubular dysfunction known as Fanconi’s
syndrome. The patient’s Fanconi’s syndrome is
manifest as evidence of a nongap metabolic
acidosis accompanied by hypophosphatemia
and glycosuria (with normal blood glucose levels).
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