CS Enzyme Homework I AM LOOKING FOR HELP WITH Q# 1,8, AND 12, any extra input on
ID: 238679 • Letter: C
Question
CS Enzyme Homework I AM LOOKING FOR HELP WITH Q# 1,8, AND 12, any extra input on questions I already answered is appreciated as well
Chemistry Case
Kathy T., a 60-year-old woman, was seen in the ER complaining of chest pain, which was moderate to severe. She had experienced substernal pain for the previous 6 to 7 weeks with dyspnea on exertion. The pain, however, had become more frequent and severe, with constant pain and pressure for the last 3 to 3 days. Kathy appeared anxious and complained of weakness, sweating, and nausea. Her blood pressure was 110/66. Her laboratory results are shown in the tables.
CHEMESTRY TABLE #1
DAY 1
DAY 4
DAY 6
DAY 9
DAY 11
REF RANGE
Sodium
136
130
139
143
153
135-145 mEq/L
Potassium
3.7
3.0
4.3
3.9
3.8
3.6-5.0 mEq/L
Chloride
94
103
107
113
114
98-107 mEq/L
CO2
25.0
24.0
23
30.0
24.0-34.0 mEq/L
Anion Gap
2.0
8.0
7.0
9.0
10-20 mmol/L
Glucose
319
519
379
310
234
80-120 mg/dL
BUN
23
53
81
99
79
7-24 mg/dL
Creatinine
0.9
1.4
2.3
2
1.9
0.5-1.2 mg/dL
Calcium
9.7
8.5-10.5 mg/dL
Magnesium
1.1
1.7
1.9
2.0
1.3-2.5 mEq/L
Digoxin
2.60
1.12
0.80-2.00 ng/mL
Cholesterol
350
0-200 mg/dL
Triglyceride
275
10-190 mg/dL
Bilirubin
0.2
0.2-1.2 mg/dL
AST
76
5-40 IU/L
ALP
84
30-157 IU/L
Total Protein
7.3
6.0-8.4 g/dL
Albumin
4.1
3.5-5.0 g/dL
TSH
0.72
0.49-4.67 uIU/mL
BLOOD GAS TABLE #2
DAY 2
REFERANCE RANGE
Arterial Ph
7.20
7.35-7.45
PCO2
63.7
35.0-45.0 mmHg
PO2
64.0
75.0-85.0 mmHg
HCO3
25.4
20.0-25.0 mmol/L
TCO2
27.4
21.0-27.0 mmol/L
Base excess
-3.3
-3.0-3.0 mmol/L
% Saturated
86
CARDIAC PROFILE TABLE #3
DAY 1
DAY 2
DAY 2
DAY 2
DAY 3
DAY 4
REF RANGE
Time
20:30
5:06
12:25
20:35
12:15
7:15
CK
668
1383
3461
3743
2117
973
24-170 IU/L
CK-MB
47.1
NT
146.6
93.0
24.8
12.1
0.0-3.8 ng/mL
Troponin I
36.6
184.0
5745.0
926.1
NT
NT
0.0-0.4 ng/mL
CK-MB EXTENDED REFERENCE RANGE
TROPONIN I EXTENDED REFERENCE RANGE
0-3.8 Normal
0-0.4 ng/mL: No evidence of myocardial injury
3.9-10.4 Borderline
0.5-2.0 ng/mL: Mild elevation, suggesting possible injury
>10.4 Significantly elevated
>2.0 ng/mL: Significantly elevated, myocardial injury
Kathy was given Nitrostat (nitroglycerine tablets) 1/150 grain prn for pain, and Inderal (propranolol HCl) was administered. She was also taking digoxin. The electrocardiogram (DCG) was performed and revealed an atrial flutter and the possibility of a true posterior infarct and lateral ischemia.
Her complete blood count (CBC) indicated a mils normocytic, normochromic anemia. The WBC was 16.4x109/L (ref range 5-10x109/L) on the day following admission.
URINALYSIS TABLE #4
MACROSCOPIC
Kathy T.
Reference Range
Color
Yellow
Colorless to amber
Appearance
Clear
Clear
Specific gravity
1.018
1.001-1.035
Ph
6.0
5-7
Protein
Neg
Neg
Glucose
2+
Neg
Ketones
Trace
Neg
Bilirubin
Neg
Neg
Blood
Neg
Neg
Urobilinogen
Normal
Normal
Nitrite
Neg
Neg
Leukocyte esterase
Neg
Neg
MICROSCOPIC
WBC
0-2/HPF
0-5/HPF
RBC
0-1/HPF
0-2/HPF
Epithelial cells
Few squamous/HPF
Few to moderate
Casts
Neg
Few hyaline
Bacteria
Neg
None
1.After reading Kathy’s initial patient history, what chemistry profile would the ER physician order on this patient? What tests are included in this profile in your laboratory, and what are the collection times?
2.What laboratory result in Table #1 and Table #3 are abnormal?
Sodium, potassium, chloride, Anion gap, glucose, BUN, creatinine, digoxin, Choesterol, Triglyceride, AST, CK, CK-MB, and Troponin.
3.The laboratory results in Tables #1 and #3 indicate what condition? Explain briefly the pathogenesis.
Myocardial infarction, MI is an extreme consequence of acute coronary syndromes. It is an ischemic necrosis of the myocardium, caused by occlusion of coronary artery and prolonged myocardial ischemia.
4. Heart muscle contains which CK isoenzyme(s)?
The myocardium contains approximately 30% of CK-MB (CK2), which has been called the "heart-specific" isoenzyme
5. How many hours after a myocardial infarction would you find an elevated CK and CK-MB? How long would they remain elevated?
Creatine kinase is released into the bloodstream 4 to 6 hours after heart cell damage occurs, and peak blood levels of creatine kinase are seen after 24 hours
6. How many hours post-infarction would you find elevated cardiac troponin, and how long would they remain elevated?
Troponin is released into the bloodstream 2 to 6 hours after heart cell damage, and blood levels peak in 12 to 26 hours
7. What is the cause of elevated AST? Elevated AST is a sign of liver damage, but it is also elevated in people with diabetes.
8. What other chemistry test(s) have been developed that could be included in a cardiac profile?
9. What acute reaction protein is rapidly gaining acceptance as an indicator of increased risk for AMI and stroke?
Myoglobin is found in cardiac and skeletal muscle. It is released more rapidly from infarcted myocardium than troponin and CK-MB and may be detected as early as two hours after an acute myocardial infarction
10. What other medical problem/condition does this patient have? What laboratory values support your decision?
This individual is definetley a diabetic in adition to the coronary issues.
11. Do patients with the condition you described in the previous questions have a higher risk of myocardial infarction or stroke than the general population? Why or why not?
Yes, individuals with diabetes have been proven to have a higher risk of heart disease and coronary syndroms.
12. Is the elevated WBC consistent with Kathy’s condition?
DAY 1
DAY 4
DAY 6
DAY 9
DAY 11
REF RANGE
Sodium
136
130
139
143
153
135-145 mEq/L
Potassium
3.7
3.0
4.3
3.9
3.8
3.6-5.0 mEq/L
Chloride
94
103
107
113
114
98-107 mEq/L
CO2
25.0
24.0
23
30.0
24.0-34.0 mEq/L
Anion Gap
2.0
8.0
7.0
9.0
10-20 mmol/L
Glucose
319
519
379
310
234
80-120 mg/dL
BUN
23
53
81
99
79
7-24 mg/dL
Creatinine
0.9
1.4
2.3
2
1.9
0.5-1.2 mg/dL
Calcium
9.7
8.5-10.5 mg/dL
Magnesium
1.1
1.7
1.9
2.0
1.3-2.5 mEq/L
Digoxin
2.60
1.12
0.80-2.00 ng/mL
Cholesterol
350
0-200 mg/dL
Triglyceride
275
10-190 mg/dL
Bilirubin
0.2
0.2-1.2 mg/dL
AST
76
5-40 IU/L
ALP
84
30-157 IU/L
Total Protein
7.3
6.0-8.4 g/dL
Albumin
4.1
3.5-5.0 g/dL
TSH
0.72
0.49-4.67 uIU/mL
Explanation / Answer
1)Complete Blood Count especially White Blood Count.
White blood cell (WBC, leukocyte)
Conditions that cause high WBC values include infection, inflammation, damage to body tissues due to heart attack.
Specimen can be collected anytime.
2)CRP : c- reactive protein
To rule out any inflammatory reaction in the body especially arteries and blood vessels.No special preparation.
3 BNP : Brain natriuretic peptide or BNP levels help doctor figure out heart failure or something else that has similar symptoms such as shortness of breath. The test also shows if your heart failure has worsened.. It is a sensitive test to allow the doctor to evaluate improvement or worsening of heart failure and to help monitor whether or not the medication is working well. No preparation required.
8) CBC,crp and BNP,myoglobin.
12) An elevated total white blood cell (WBC) count is a risk factor for atherosclerotic vascular disease. WBC-derived macrophages and other phagocytes are believed to contribute to vascular injury and atherosclerotic progression . Several studies have a positive an association between WBC count and coronary heart disease incidence or mortality. So , an increased WBC is an important parameter.