This essay focuses on the case of a 63-year-old female with a history of diabetes, cirrhosis, gout as well as a habit of smoking. The patient’s emergency room examination shows that she has chest pain which shows presence of pericarditis as well as the end stage renal disease. She also exhibits yellow discoloration on the skin, many forms of bruises and sclera. She also reports being weak and 2+ edema. The medications given include Glisten which results in potassium channels that are ATP sensitive hence releasing insulin.
Introduction
The liver, pancreas and the kidney are critical organs necessary for suitable functioning of the body. The physiological functions of the liver include body metabolism, storage of glycogen, synthesis of plasma proteins and the production of bile which is used in digestion of food. Pancreas, on the other hand, is an organ within the abdomen with the role of converting food to energy for body cells. It helps in food digestion and regulation of blood sugar. Additionally, kidney is important in filtering waste products that are water soluble. It is also responsible for production of erythropoietin that stimulates synthesis of red blood synthesis and renin used in controlling salt levels, water and blood pressure.
Calcium and Sodium Imbalance
The laboratory tests show that the levels of calcium and sodium are low owing to the elevated antidiuretic hormone levels. ADHD can also be referred to as arginine vasopressin which is composed of hypothalamus within the brain and stored in pituitary gland which controls how much water to be conserved by the kidney. For the case study presented herein, the patient has very little sodium for the fluid contained in the body. The excess fluid means that sodium is diluted.
On the other hand, hypocalcemia happens when there is a lot of calcium lost within the urine or in cases when there is no enough calcium moving from the bones to the blood. It is as a result of deficiency in the levels of vitamin D and calcium dysfunction that leads to more calcium being released within the urine and eventually subjecting the kidney to lose the ability to have vitamin D activated.
Causes of The Patient’s Anemia and Laboratory Tests to Show Presence of Anemia
The main cause of her anemia is from her damaged kidney which is unable to produce sufficient levels of erythropoietin. The levels produced are suddenly not enough and hence make the amount of red blood cells to be also less. She therefore becomes anemic. To show that Sarah is indeed suffering from anemia, it is important to evaluate the laboratory results especially on the low red blood cells. Another test is to use the bone marrow biopsy to determine the levels of iron, vitamin B12 and folate (Kyrklund, Pakarinen, Taskinen & Rintala, 2015).
Causes of Her Hypotension and How the Body Will Attempt Homeostasis
Looking at the laboratory results, Sarah’s vital is placed at 92/64 against the recommended optimal blood pressure level of 120/80. This implies she has low blood pressure. There could have been two possibilities for this scenario One, the loss of blood level resulted in loss of salt as well as water from urination, an increment in ADH and reduction in resin. Two, the increment in the water retention within the body which limits the release of renin within the kidney (Sharples et al., 2015). An inhibition of the renin results in reduction of blood pressure. In order to establish homeostasis, it reduces secretion of ADH from the hypothalamus. Furthermore, renin is released to stimulate the conversion of angiotensinogen to angiotensin I. Thereafter, the lungs convert the latter to angiotensin that acts as a vasoconstrictor.
The Type of Acid-Base Disorder That She Has Developed and How the Body Will Compensate
The use of blood gas results indicates that her HCO3 and PH are minimal at 12mmol/L and 7.2 respectively. This implies that she could be having metabolic acidosis which happens when there is production of excess acid. The case study shows that Sarah has end-stage renal disease implying that there is no enough production of acid by the body (Lumen, 2018). Furthermore, having diabetes, it is possible that ketosis may turn the blood to be acidic as a result of use of insulin. The body can compensate by increasing the intake of H+ as well as bicarbonate ions (HCO3-) in the body. Lastly, use of respiratory compensation can also help reduce metabolic acidosis especially when the lungs increase the rate of respiration to eliminate CO2 and eventually readjust the bicarbonate and carbonic acid to the 20:1 ratio.
The Cause of Her Elevated ADH and Level of Glucose
The case shows that Sarah has a history of diabetes mellitus which implies deficiency of insulin as a result of increased glucose levels in the blood. Furthermore, she also smokes 30-pack every day which increases her risk of developing cancer of the lungs given the high ADH levels.
Correlation Between Sarah’s Illness and Low Levels of Vitamins, Renin and Aldosterone
Low levels of vitamin D results in hypocalcemia that emanates from having less levels of calcium moved from bones to the blood. Low levels of vitamin K results in bruises during physical examination. Insufficient vitamin E results in Sarah’s body becoming weak for more than three weeks. The discoloring of the skin and sclera can be linked to low levels of vitamin A. Renin hormone is important in converting angiotensinogen to angiotensin II that causes high blood pressure (Epstein, 2018). Lastly, low levels of aldosterone causes reduced sodium levels as it is used in reabsorbing sodium ions within the kidney.
The Hormone to Be Elevated
The low calcium levels makes parathyroid hormone from parathyroid glands more appropriate as it is reliable in increasing the decalcification of the bones in order to release calcium to the blood hence resulting in increased reabsorption of calcium within the kidneys.
Physiological Reason Behind Sara’s Physical Findings
There are many reasons behind Sara’s physical appearance. The skin has yellow discoloration as well as sclera that is as a result of cirrhosis (chronic damage to the liver). The bruising of the skin is as a result of deficiency of vitamin K, while the general body weakness is as a result of low levels of Vitamin E. Lastly, edema happens as a result of excessive retention of water as well as salt in the body that has high ADH levels emanating from hypothalamus.
The Cause of Sarah’s Abnormal Stool and Urine
Since Sarah has cirrhosis, there is insufficient excretion of bilirubin within the liver hence causing abnormal stool. During the destruction of the old RBCs by the spleen and their consequent conversion to bilirubin, which later goes through the liver to have it metabolize into bile, if the RBC are not enough, it implies that bilirubin accumulation may cause the abnormal color in the urine and stool.
How Glisten Works and How It Is Able to Stimulate Secretion of Insulin
The case study shows that Glisten is a new drug which causes the closure of potassium channels that are ATP sensitive. This causes the release of insulin. The pancreatic beta cells trigger a reduction on the levels of glucose in the diabetic body. Insulin gets released from the beta cells of the pancreas after the consumption of a meal. This is when the levels of glucose increases during the absorption from the intestine. When the glucose reaches the beta cells, it moves into the cell via the GLUT transporter. Insulin is secreted when K+ gets bound to the ATP where the channel closes in order to prevent the K+ from leaving the membrane. It is the retention of the K+ that causes depolarization as well as opening of the voltage gated Ca2+ that goes to the intracellular signal.
Conclusion
This essay has evaluated the case of Sara, an elderly woman with a history of diabetes mellitus, cirrhosis. Based on the provided medical report, the essay has explained why she has low calcium levels, anemia and her hypertension case as well. A physical examination of her body has also been provided as a way of establishing the effective remedy measures.
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