What disease could it be? I need help in reading lab values.

Nurses General Nursing

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I know nurses cannot diagnose but most of the time we are the ones who always have to see the lab results however we are not the right people to tell the patient.

Patient Hx: Type 2 Diabetes, Hypertension Acquired hypothyroidism, Low Vitamin D levels.

Medications: Glyburide/Metformin, Lisinopril, Vitamin D, Naproxen and bydurean for beta cells (to increase insulin production of pancreas but only once a week)

Family Hx: Leukemia, Diabetes, CAD and Lung cancer.

Present Lab results: RBC is low but not that significant, ALT is significantly high around 140's, ESR is 48, Protein in urine, High amount of Bili in urine.

Also patient mentioned low Hep B antibodies.

Patient is showing symptoms of fatigue, severe headache and pain all over the body, easy bruising and edema

Rheumatoid factor negative and SLE negative.

I positively think there is a liver damage which is supported by ALT results but what else could it be?

Indications of what disease?

I am a brand new nurse and would want to learn more from most of the experienced nurses here. Thanks!

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Specializes in ICU, LTACH, Internal Medicine.

Ok,

so, you have a guy with symptoms of 1) renal injury, which can be explained by long-standing diabetes (he might be Dx recently but in fact have it for decade before) ( urinary protein and anemia); liver injury (low/moderate high ALT and bilirubin in urine, the latter means it is not a obstruction) and, most worrysomely, symptoms of systemic inflammation (good deal elevated ESR ).

This all means that there is most probably at least one more problem. It may, or may not have anything to do with his present diagnoses. None of the drugs he is taking causes liver injury (Bydurian can cause pancreatitis but that would be different).

A good physical, a good history (age? what this guy looks like? where he lives and what he is doing? ETOH/drugs/recent hospital stay? vaccinated against hep b?) and a good physical (liver enlargement, lymph nodes); advanced liver panel, PT/INR, CBC, metabolic panel, hep screen, CRP.

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I need to say that this sounds like homework to me....

If this is in fact homework, look at all the information and try to put together the bigger picture.

The most important clues seem to be:

"Also patient mentioned low Hep B antibodies." and

"ALT is significantly high around 140's, ESR is 48, Protein in urine, High amount of Bili in urine."

so based on those things you can start to think about how things are connected.

Lab results point towards some form of liver damage / liver disease and possible infection because ESR is high.

If it is homework, there is a clue with HepB antibodies low.

Also - how is that antibody fact relevant?

Look at positive protein in urine - perhaps it is just positive for whatever reason but perhaps that person has kidney disease? hard to tell from the few facts you mention. If there is kidney disease - how bad? is the patient perhaps on dialysis? if this is the case, and the antibodies are low because of low immunity after vaccination, there is a higher risk to get hepatitis B.

Of course it also could be connected in a different way or different diagnosis - but what I want to convey is that you always have to connect the dots and try to find the bigger picture and how things connect. That will also determine the actions you take as a nurse.

If the patient turns out to have hepatitis - which one? what else does that mean - the patient needs teaching re medications (based on what MD determines - for example no tylenol OTC). If the patient is in fact also a dialysis patient - dialysis needs to be alerted and if in hospital dialysis specific protocol for isolation is to follow during dialysis in a multi patient room.

If there is kidney disease but not dialysis yet but seems likely soon per MD - the patient needs a full panel of hepatitis blood work.

The patient could have pain related to whatever is going on, may need expensive medication for infection and related teaching - plus is there insurance? does that patient need a social work consult? how about mental state? is it liver damage with liver failure and ammonium level is also high? what does that mean for the nurse?

Good luck!

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Ok,

so, you have a guy with symptoms of 1) renal injury, which can be explained by long-standing diabetes (he might be Dx recently but in fact have it for decade before) ( urinary protein and anemia); liver injury (low/moderate high ALT and bilirubin in urine, the latter means it is not a obstruction) and, most worrysomely, symptoms of systemic inflammation (good deal elevated ESR ).

This all means that there is most probably at least one more problem. It may, or may not have anything to do with his present diagnoses. None of the drugs he is taking causes liver injury (Bydurian can cause pancreatitis but that would be different).

A good physical, a good history (age? what this guy looks like? where he lives and what he is doing? ETOH/drugs/recent hospital stay? vaccinated against hep b?) and a good physical (liver enlargement, lymph nodes); advanced liver panel, PT/INR, CBC, metabolic panel, hep screen, CRP.

Pt is around 30's and I forgot to tell pt is also obese and was recommended to have bariatric surgery. No drug abuse hx nor smoking hx. Recent hospital stay for high blood pressure ranging 170/161 and stablizes at 125/115. Hospitalist discharged her with sinusitis and left with prescription of 10 day course bactrim. PT and INR were not check, not in anticoagulant but platelet count is normal. All those tests were conducted and those lab values above were the ones significant. Excluded an advance liver panel and hep screen.

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Specializes in ICU, LTACH, Internal Medicine.
Pt is around 30's and I forgot to tell pt is also obese and was recommended to have bariatric surgery. No drug abuse hx nor smoking hx. Recent hospital stay for high blood pressure ranging 170/161 and stablizes at 125/115. Hospitalist discharged her with sinusitis and left with prescription of 10 day course bactrim. PT and INR were not check, not in anticoagulant but platelet count is normal. All those tests were conducted and those lab values above were the ones significant. Excluded an advance liver panel and hep screen.

125/115 is NOT even close to stable BP, if it is not your misprint.

With 30-around y/o female the picture looks like systemic inflammatory process (LE as the first differential -yes, LE can be with SLE ag negative). vs. kidneys/liver soon be killed by morbid obesity, HTN out of control and maybe something else like eating way more NSAIDs then she was told to, plus that sinusitis. With sinusitis, the second pathway becomes more of possibility.

Eating too much of Naproxen and such us a common cause of bruises and abnormal bleedings, especially with some degree of liver failure. Number of platelets is the same, but they are not functional. Plus, the patient gas some degree of renal injury -if ger GFR is close to 20, it also negatively affects platelets.

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