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Hospital discharge of a 75-year-old man is delayed due to unavailability of a bed in a nursing home. He is bedridden and unable to attend to his personal needs. During a 3-day period, his pulse increases from 82/min to 125/min, and blood pressure decreases from 124/72 mm Hg to 100/55 mm Hg. Laboratory values include:
Day 1
16.4 g/dL
18 mg/dL 100 mg/dL 135 mEq/L 1.1 mg/dL
Hemoglobin Serum
Urea nitrogen Glucose
Na+ Creatinine
Day 3
18.4 g/dL
56 mg/dL 89 mg/dL 151 mEq/L 1.2 mg/dL
Which of the following is the most likely diagnosis?
(A) Acute renal failure
(B) Dehydration
© Diabetic ketoacidosis
(D) Gastrointestinal hemorrhage
(E) Syndrome of inappropriate ADH (vasopressin)
plz answer with explanation
thanks
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Choice B is the correct answer.
clues to that : the pt was not able to attend his personal need, hypotension and tachycardia, the rapid rise in Hb by 2 g/dL in a matter of two days indicates hemoconcentration, and the dissociation in the rise of urea withoyt a significant rise in creatinine excludes renal failure,
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hemococentration excludes GI bleeding, rising Na excludes SIADH, and euglycemia excludes DKA.
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b is correct.
thanks for the explanation.
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Why answer isn`t ARF - i know its B but what is key finding that steer us towards dehydration and not ARF .ARF can happen in 3 days ...Hb isn`t that big criteria ..Anyone with better explanation of
Dehydration Vs ARF
will be appreciated - Thank You
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Not ARF because Creatinine is WNL.
hemoconcentration explains everything here.
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@becker14, BUN 56/1.2 = 46.. greater 20 -> “Prerenal that buildup nitrogen waste in blood” compare the BUN days 1 and day 3 u notice BUN it gone UP 38 and Cr 0.1 and make kidney on stress, however if pat continue this pat -> *kidney damage-> DEC GFR - > KF-> Death ( with info on 3rd day present -> Simple dehydration )
Q) IL-? can be detected in the urine in *parenchymal injury that form PCT.
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MC prob in "nursing home".
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Thank you @cardio69 for detailed explanation and @pinkrose for making it simple .
parenchymal injury IL
procalcitonin (PCT), interleukin 6 (IL-6) and interleukin 8 (IL-8)
