We received a mock lab report in class to analyze and for a possible diagnosis based on abnormal results. First, having to note which are abnormal, then go from there based on one hint given to us. Then add any other measures to be taken and assessment.
I'd like to share the first one I'm working on (maybe the other two as I get to them) just to see if I'm on the right track and I would love any input, I really want to get a handle on understand what should "jump out" at you upon seeing the abnormals.
pt (male) hint : scheduled for GI series with dye
Normals in ()
Sodium 130 (135-145)
Potassium 3.0 (3.5-5.0)
Chloride 94 (95-108)
BUN 42 (8-20mg)
First off what "jumped out" at me was the BUN count. Excess proteins in the blood (excessive protein catabolism). At first I thought kidney complications/renal failure, but with the hint I'm thinking GI bleeding. This leads me to a possible Ulcer?
One area I am a bit unclear about is how the BUN and Creatinine (ratio) are related, if anyone could help explain this it would be greatly appreciated. Another is the Na,K and Cl, they are lower than the normals but not critically, I was not sure just how abnormal they were.
Am I at least on the right track? Ulcer? hemorrhage/GI bleeding? Or should I stick with thinking renal?
I really would appreciate any help!
Oh, and by the way, I'm a newbie, 5 weeks in and going strong. I check this site now every day and I've found such a wealth of knowledge here, I only hope in time to be able to contribute.
Oct 13, '07
I think you are definitely on the right track in your analysis. The elevated BUN could certainly be secondary to GI bleeding, but I would bet that it is renal because with the Creatinine being elevated the BUN elevation would most likely be renal as well. The Creatinine would not be changed by a GI bleed. (but the BUN could be, unless it was lower GI). This guy looks like he has some pretty significant renal insufficiency going on here, but what is strange is that his potassium is low. If this were a chronic problem, one would expect to see a higher K+. Did he recently have an angiogram or something with dye that put him into acute kidney failure? What meds does he take? If he is on a loop diuretic (lasix) his K+ could be low from that. Now, that all of the lytes that they show you are low, I also wonder about his nutritional status. I will bet he is malnourished. Maybe he is malnourished because his gut hurts, thus the GI series?
Of course I would want to know his medical history and the medications that he is on. Is he being seen by Renal? If not, he should be. If the guy has long term uncontrolled HTN, the renal failure could be from that. They don't tell you a whole lot do they?
Also, remember that when the NA levels drop, confusion usually increases, although he is not very low, at this point, it is something to consider.
Last edit by deeDawntee on Oct 13, '07
Oct 14, '07
Ok, so.... lol (it's my nature to "over" analyze hehe)
Per pt labs, he's dehydrated (decreased electrolytes), which would be a result in a decreased fluid intake or vomiting/diarrhea and decreased urinary output resulting in elevated urea in the bloodstream. Pt vomits/diarrhea, and trauma to the Upper/lower GI results in bleeding. This elevates the BUN (digested blood is a source of urea) and decreases the electrolytes (dehydration).
I did read that increased protein would effect BUN levels, do I understand that correctly? Maybe thats why I got hung up on the proteins. Water to salt plays a part here as well, right?
I'm not dense! I promise, just trying to put it all together in a flow chart aspect for better understanding. If this, then this, then this relates to this kinda thing.
One thing, if you all don't mind me asking is, when you looked at the lab values, what jumped out at you first? Was it the electrolytes or bun/creatinine levels? I think what my problem may have been is I looked at the BUN first because there was such a difference. I think what I need to do in the future is know that any abnormality is important even in the slightest to determine a possible diagnosis.
Looking forward to your responses!! Thanks so much!
Last edit by litlamp on Oct 14, '07
: Reason: added last question