The patient described in this case has multiple-organ involvement; therefore, the clinician requested a significant number of diagnostic tests, including clinical laboratory tests, to rule in and rule out various diseases and disorders.
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The patient described in this case has multiple-organ involvement; therefore, the clinician requested a significant number of diagnostic tests, including clinical laboratory tests, to rule in and rule out various diseases and disorders.
Wanda, a 65-year-old woman who is a chronic alcoholic suddenly collapsed at home and was transported to the emergency department (ED). Her medical history includes hypothyroidism, chronic renal impairment, and osteopenia. The patient complained of mild epigastric pain, with occasional pain radiating to the right costal margin. She denied chest pain, headache, or vertigo. She had shortness of breath (dyspnea) on examination. Her medications consisted of furosemide (a diuretic), potassium, captopril (ACE inhibitor), and thyroxine. She has smoked for about 30 years.
Physical examination revealed a tired and lethargic-looking woman. Her weight was 130 pounds and her height was 61 inches. Her blood pressure was 110/70 lying down and 90/60 sitting down, with a pulse rate of 102 beats per minute. Other significant findings were crepitus (crackling or popping sound) in her chest, marked cardiomegaly, and pulmonary edema.
Issues and Questions to Consider
- Identify several clinical observations relevant to Wanda’s history and physical examination.
- List examples of diagnostic laboratory and nonlaboratory (e.g., X-ray) tests that may provide the clinician with useful data to support clinical findings.
The results of clinical laboratory tests and additional diagnostic tests are as follows:
| Blood Chemistries | Results | Reference Interval (RI) |
|---|---|---|
| Sodium (mEq/L) | 144 | 136–145 |
| Potassium (mEq/L) | 4.4 | 3.5–5.1 |
| Chloride (mEq/L) | 101 | 98–107 |
| Bicarbonate (mEq/L) | 7 | 23–29 |
| Anion gap (mEq/L) | 36 | 6–10 |
| Glucose (mg/dL) | 100 | 74–100 |
| Creatinine (mg/dL) | 2.5 | 0.9–1.3 |
| Urea nitrogen (mg/dL) | 11.2 | 6–20 |
| Lactic acid (mg/dL) | 88.3 | 5–12 |
| Calcium (mg/dL) | 8.9 | 8.7–10.0 |
| Phosphate (mg/dL) | 3.1 | 2.5–4.5 |
| Magnesium, mg/dL | 1.2 | 1.5–2.3 |
| Albumin (g/dL) | 3.1 | 4.0 |
| Gamma glutamytransferase (U/L) | 389 | 1–25 |
| Ethanol | Not detected | Undetectable |
| Alkanine phosphase (U/L) | 250 | 40–115 |
| Alanine amino transferase (U/L) | 1880 | 0–55 |
| Asparate amino transferase (U/L) | 7542 | 5–34 |
| Lipase (U/L) | 125 | 13–60 |
| Troponin I (ng/mL) | 0.48 | 0.04 |
| B-type natriuretic peptide (pg/mL) | 458 | ≤106 |
| pH | 7.10 | 7.35–7.45 |
| Thiamine (nmol/L) | 2.7 | 70–180 |
| Erythrocyte transketolase (U/L) | 34 | 150–200 |
| Other nonclinical laboratory tests: | ||
| Left ventricular ejection | Normal | |
| Fraction (%) | 32 | >50 |
Issues and Questions to Consider
- Based on all of the information provided, including laboratory tests, identify possible medical disorders affecting this Wanda.
- What is the relationship between the increased serum BNP and the decreased thiamine levels?
- What type of assay is erythrocyte transketolase?
- Explain why erythrocyte transketolase is decreased.
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