Initial Chemistry Values

Blood Chemistry Value Normal Range Patient Value
Glucose 90-120 mg/dl 165 mg/dl
BUN (Blood Urea Nitrogen) 7-24 mg/dl 53 mg/dl
Creatinine 0.7-1.4 mg/dl 3.8 mg/dl
Calcium 8.5-10.5 mg/dl 7.3 mg/dl
Sodium 134-143 mEq/L 152 mEq/L
Potassium 3.5-4.5 mEq/L 5.0 mEq/L
Chloride 95-108 mEq/L 119 mEq/L
CO2 20-30 mEq/L 14.0 mEq/L
Blood pH 7.38-7.42 7. 33

Instructor's Note:  As we see from these results, tests that reflect the ability of the kidney to excrete wastes are quite elevated: notably the blood urea nitrogen (BUN) and creatinine tests.  Creatinine excretion is relatively constant, and even slightly elevated serum levels are a significant indicator of renal insufficiency.  Note also the electrolyte values show a diminished capacity of her kidneys to regulate acid-base balance. Here, we see results indicating the beginning of metabolic  acidosis. As you recall from the diabetes case , acidosis occurs when the blood pH falls below 7.38. The early acidosis we see here is due to the kidney's inability to secrete excess hydrogen ions and conserve bicarbonate, the body's key buffering substance.  Another concern the physician will have is the patient's potassium level is above normal.  As hydrogen ions increase, intracellular potassium (K+) moves to the extracellular fluid and serum K levels rise. This condition is called hyperkalemia and poses a danger of disrupting the heart's conduction system. Hypernatremia, which is the retention of sodium (Na+), is a major factor in the fluid retention seen in this patient. 

12.  What 2 blood chemistry values are reflective of the kidneys ability to excrete waste?
13.  Why are these values elevated in this patient?
14.  What blood chemistry values indicate the patient is in metabolic acidosis?
15.  What are the dangers of a high K+ level?
16.  Why is the patient experiencing edema?

Urinalysis results also show kidney malfunction.  Protein and glucose are normally filtered by the kidneys and should not be present in the urine.  White and red blood cells are indicative
of damage to the kidneys, as are casts in the urine.  The student may wish to review the urinalysis site found earlier in the case.

Urinalysis Results

Urinalysis Value

Patient Values

 Normal Values
Protein 2 gm/dl absent 
Specific Gravity 1.005 1.005-1.030
pH 5.0 5.5-6.5 (avg. range)
Glucose present (3plus) absent
Blood (hemoglobin) 2 plus absent
Casts granular and epithelial cells 3-5 per low power field absent or rare
White Blood Cells 5-10 per high power field (p/hpf) 0-1 p/hpf
Red Blood Cells 5 -10 p/hpf rare
Epithelial Cells (renal) 25-50 p/hpf 0-3 p/hpf

 
 

17.  Does the presence of glucose and protein in this urine sample indicate the patient may also be diabetic?  Why or why not?
18.  What are urinary casts?  What factors contribute to the formation of casts in the urine?
19.  What results from the urinalysis point to acute renal failure?
20.  Which health care professional is responsible for testing the blood and urine sample?