Please explain and answer questions 5,7, and 11. Given: HPL: A 60 kilogram Afric
ID: 3509990 • Letter: P
Question
Please explain and answer questions 5,7, and 11. Given: HPL: A 60 kilogram African-American male, 55 y, is admitted to the Medicine ICU with progressive dyspnea PMH: He has a history of refractory hypertension and long-standing COPD with cor pulmonale from R ventricular MI five years previous; PFT's, from a year ago, when he was stable, revealed the following parameters/values: FEV10-1S, TLC = 7.5 L, RV-2L, DLCO 12 mL/min/mmHg. Here are following values/parameters/therapies: Nutrition: an of D5w @ 100 mL/hr, with an NG-feeding-tube of Pul mocare" (50% fat, 1.5 Kcal/mL) @ SOmu hr. Urine output: 25 mL/hr Venous creatinine: 2 mg/dL Oxygen administration: 4 L/min nasal cannula (estimated FIO2 0.36) Resting ventilation related parameters: VE 8 L/min (BTPS), oxygen consumption 270 mL/min & carbon dioxide production 200 mL/min (both STPD). Mixed exhaled CO2-22 mmHg. ABG's pHs 7.45, PaCO2 = 50 mmHg, PaCO2-50 mmHg, Sao, 80% Hemoglobin: 20 g/dL Vitals: 37 C, RR -30, 135/90 mmHg (on anti-hypertensive medicines and aspirin). EKG rhythm strip (six seconds, from HR monitor): Mixedvenous oxygen: 33 mmHg with SvO2 65%. Heart pressures: RAP 7 mmHg, Pulmonary artery 40/15, LAP 10 mmHg Chest X-ray: Left Lower Lobe consolidated, which is likely caused by pneumonia. Questions: 1. What is, in general, his kidney status? What is his I and O? What is his GFR (high, low, WNL)? IGNORE THIS Q 2. What is likely the cause of his systemic hypertension?-Siress /hormonai teuess 3. How many kilocalories is he receiving? IGNORE THIS Q 4. What is his RQ value? Is it lower or higher than expected? If so, why? 5. Is his metabolic rate WNL? If not, low or high, and why? What is the likely cause if abnormal? 6. What is his CO? Is it low or high? Would it be equal to both lungs? Why or why not? 7. What is his MAP for the systemic and pulmonic circuits ? Are both of them WNL? If not, which ones. If abnormal, what is/are the likely cause(s)? 8. What is his SV? 9. What is his HR? 10. What is his SVR? What is his PVR? 11. what is his overall va? what is his dead-space % what is his shunt % IGNORE SHUNT % PART OF THIS Q 12. What would be (probable) the VQ of the R and L lungs if considered individually? 13. What type of COPD does he have? That is, is it a predominance of emphysema or chronic bronchitis? Why? 14. What is his A-a gradient? 15. Why is his hemoglobin high? 16. Would his O2 sat-desaturation curve shifted R or L? 17. Interpret his ABG's? IGNORE THIS QExplanation / Answer
Question 5-
According to the Katch-McArdle Formula
BMR= (10 × W) + (6.25 × H) (5 × A) + 5
Here W is the weight in Kg, H is the height in centimeters, and A is the age in years.
We expect the average height of an African American male is 5 feet 7 inches.
W =60 Kg
H= 5.7 feet = 1.7 meter = 170cm
BMR = 600+ 1062.5 – 275 +5
BMR = 1392.5 calories
Here LBM is the lean body mass in kg
LBM (for male) = (0.33 × W) + (0.34 × H) 29.53
The patient is in lower metabolic rate because the patient higher PaCO2 level, which must lie within 40 – 45 mmHg and lower Oxygen Saturation that is 80% ( normal is 90-95%). Here the patient is not getting adequate amount of oxygen in blood; therefore, less energy is forming. He must get lower calories per day than 1392.5 calories.