Renal System and Acid Base Physiology Case #1 A 39-ycarold male with a history o
ID: 63296 • Letter: R
Question
Renal System and Acid Base Physiology Case #1 A 39-ycarold male with a history of insulin dependent diabetes mellitus was treated for a urinary tract infection (UT!). After several days, he began feeling better and completed his antibiotic regimen as instructed. He presents to your office today, eight days after completing his antibiotic regimen. complaining of a persistent, moderate, right flank pain. Physical exam reveals an ill-appearing male. dehydrated, and without fever. His heart rate is 110, respiratory is 20, and his blood pressure is 180/100 mmHg. Non radiating right costovertebral angle and right lower quadrant tenderness are elicited on palpation. The patient is sent for baseline blood and urinalysis work-up which reveals: What is the most likely diagnosis? Does the urinalysis support the diagnosis? If so, how? What is the significance of the decreased bicarbonate value? What can you conclude regarding the patient's BUN and creatinine values?Explanation / Answer
* Acute pyelonephritis
* High levels of BUN and creatinine indicate renal failure, and support the diagnosis.
* It indicates loss of bicarbonate through diarrhea, or renal tubular wasting. Bicarbonate levels correlate inversely with chloride levels. Decreased bicarbonate means increased chloride, which suggest metabolic acidosis.
* BUN and creatinine values are elevated, suggesting a renal failure