A daughter goes to visit her elderly mother, who lives alone. The mother wants t
ID: 87782 • Letter: A
Question
A daughter goes to visit her elderly mother, who lives alone. The mother wants to remain as independent as possible, but her ability to prepare meals has recently declined. As a result, her nutritional status and health have declined. When the daughter arrives at her mother's house, she finds her mother still in bed and incoherent, clammy, and hot to the touch. She calls 911, and her mother is rushed to the emergency department (ED). In the ED, her mother is found to have a fever, and she is unable to answer questions about how she has been feeling lately. The care team consults with the daughter about ordering laboratory analysis, and she gives her consent for the blood draw. Additionally, the daughter consents to the placement of a urinary catheter because the mother is not able to collect a urine specimen independently.
Electrolyte and liver analysis results Continue to urinalysis results Reference Range Liver analysis Electrolytes 142 135-147 mEq/L 55 U/L ALT Na mEq/L 4.9 3.5-5.2 mEq/L 201 U/L ALP mEq/L 101 95-107 mEq/L 49 U/L AST mEq/L 7 mg/dL Phosphate 4.2 mg/ 2.4-4.5 mg/dL Bilirubin dL Albumin BUN 1.9 g/dL 12 mg/dl 8-25 mg/dl 0.1 mg/ 0.5-1.5 mg/dl 61 U/L Cr GGT Glucose 105 mg/ 60-110 mg/dl Ca2+ 9.2 mg/ 8.8-10.3 mg/dL dL Reference Range 7-55 U/L 45-115 U/L 8-48 U/L 0.1-1.2 mg/dL 3.5-5 g/dL 9-48 U/LExplanation / Answer
1. D. This is a case of nitrituria i.e. as the patient has tested positive for nitrites in the urine. Hence this is a case of urinary tract infections (UTI) due to a gram-negative organism, Escherichia coli. Further is is also a case of bowel obstruction as the ASP and bilirubin levels are high. (option D is correct)
2. The route of infection affects the host immune response hence contributes to the development of sepsis. Hence option: B is correct
3. A class of proteins playing a key role in the innate immune is Toll-like receptors (TLRs). Hence option: A is correct
4. The C.B C of the mother confirms infection as her WBC count is high.