Case Study 5: (28-1) Part 1 A 38-year-old man entered the emergency department w
ID: 168582 • Letter: C
Question
Case Study 5: (28-1) Part 1
A 38-year-old man entered the emergency department with the complaint of severe, mid-abdominal pain of 6 hours duration. A friend, who had driven him to the hospital, stated that the patient fainted three times as he was being helped into the automobile. The patient had a 15 year history of alcoholism and drank 1 to 2 pints of whiskey per day. He has been hospitalized for acute alcoholism 3 months ago, at which time he had minor abnormalities of liver function. On this admission, his blood pressure was 80/40 mm Hg; pulse 110 /min and thread. Respirations: 24/min and shallow.
Lab results:
Amylase- serum
640 units (3.5-260 units)
Sodium- serum
133 mmol/L ( 135-145 mmol/L)
Potassium- serum
3.4 mmol/L (3.8-5.5 mmol/L)
Calcium- serum
4.0 mmol/L ( 4.5-5.5 mmol/L)
BUN- serum
32 mg/ dL ( 8-25 mg/dL)
WBC
16, 500/ uL
HGB
12 g/dL
Questions: Answer in complete sentences and defend your answers.
What is the probable disease?
The etiology of chronic pancreatitis is similar to that of acute pancreatitis, but chronic excessive alcohol consumption appears to be the most common predisposing factor.
What is the cause for the low serum calcium?
Hypocalcemia may be found and has been attributed to the sudden removal of large amounts of calcium from the extracellular fluid because of impaired mobilization or as a result of calcium fixation by fatty acids liberated by increased lipase action on triglycerides.
What is the cause for the increased blood urea nitrogen?
Amylase- serum
640 units (3.5-260 units)
Sodium- serum
133 mmol/L ( 135-145 mmol/L)
Potassium- serum
3.4 mmol/L (3.8-5.5 mmol/L)
Calcium- serum
4.0 mmol/L ( 4.5-5.5 mmol/L)
BUN- serum
32 mg/ dL ( 8-25 mg/dL)
WBC
16, 500/ uL
HGB
12 g/dL
Explanation / Answer
The first 2 questions are obviously answered and lead to the third and unanswered question:
What is the cause for the increased blood urea nitrogen?
Increased blood urea nitrogen (BUN) levels here are rightly indicative of impaired kidney function.
BUN concentrations are elevated when there is excessive protein breakdown (catabolism), significantly increased protein in the diet, or gastrointestinal bleeding (because of the proteins present in the blood).
Point noteworthy is that, if one kidney is fully functional, BUN concentrations may still be normal even when significant dysfunction is present in the other kidney. So, there is a high probability that both the kidneys could be damaged.
Research taken up for relating increased BUN and pancreatitis have also concluded higher BUN levels correlating with higher odds of mortality.