guangyu
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A 40-year-old woman is brought to the emergency department with complaints of severe weakness, back pain, and anorexia for the past three days. She has a history of a well-controlled connective tissue disease. Physical examination is remarkable for dry oral mucosa and decreased muscular strength, symmetrically. She has a history of coronary artery disease and does not know which medications she takes. The following lab values are obtained:
White cell count 14,000/mm3; hematocrit 36%; sodium 134 mEq/L; potassium 3.0 mEq/L; chloride mEq/L 118; bicarbonate 15 mEq/L; BUN 42 mg/dL; creatinine 1.9 mg/dL; glucose 100 mg/dL.
Arterial blood gas on room air -- pH 7.30; PCO2 29 mm/Hg; HCO3- 12 mm Hg; PO2 70 mm Hg.
Urinalysis -- specific gravity 1.030; pH 6.5; protein 1+; red cells 10-20/hpf.
Which of the following would be the most appropriate test?
(A) Urine electrolytes
(B) Spiral CT scan of abdomen
(C) Urine osmolarity
(D) Serum osmolarity
(E) Fludrocortisone stimulation test
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| GOGETA
I'm Dr. GOGETA
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I will go with F
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| guangyu
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| Vietnamese
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D
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| mikky
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it is our choices that show what we truly are, far more than our abilities!!!!
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| arlete
Attending in 2012!!!!!
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A
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| guangyu
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| mangoshaikh
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I would go with urine electrolytes..A.....i think its RTA...possibaly due to NSAIDS for musscular connective tissue disease. Now what i know is the ph is low, bi carb is low i want to see if the urine ph is high and urine hco3 is high. if it is we are loosing Hco3 and its type 2 RTA. 
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| Anand007
Forum Senior
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answer is A
connective tissue disease wit renal problems is suggestive of SLE.. autoimmune diseases are associated wit type 1 RTA.. also urinalysis shows a high Ph.. urine bicarbonate wil be high.. also this case has normal anion gap metabolic acidosis..highly s/o RTA
Edited by Anand007 on 06/06/08 - 09:01 AM
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| DrVirgo
Forum Hero
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ITs not F A or D? guangyu Whats the answer?
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| peter90036
Forum Elite
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i'd go with C
i dont see the benefit of knowing urine electrolytes
first there needs to be a diagnosis
Edited by peter90036 on 06/05/08 - 11:37 AM
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| hero
Forum Guru
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how urine osm better than serum osm to establish Dx?
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| hero
Forum Guru
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B - back pain and RBCs in urine?
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| guangyu
Forum Elite
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peter is right, it is type 1 RTA
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| Anand007
Forum Senior
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yeah..it is type 1 RTA..but wot would b d next step? urine electrolytes or urine osmolarity? kindly explain
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| avincina
Forum Newbie
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Hay guys am new here ,,,I think it is type IV RTA ,,& I think that E is the rt answer ,,,correct me f am wrong pls ,,,
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