Question

Latanya is a 24-year-old woman, admitted in the hospital yesterday with a chief complaint of increase urination and excessive thirst. Her symptoms began six months back. Prior to that time, she voided approximately about three to four times per day. She is now voiding about 8 - 10 times per day. She feels tired and dizzy at work. Three days back she visited ER for altered mental status.

O/E: She had severe dehydration, blood pressure 90 / 50 and heart rate was 135 / minute. In the ER some blood and urine tests were done, two bags of 0.9% NaCl (saline) i.v fluid were infused and her blood pressure was stabilized. She was discharged from the ER at about 11:00 PM, last night. She was advised to see her physician for follow-up check-up in a week, but she was admitted again at 9:00 AM today because of excessive urination and dizziness. She has a family history of high blood pressure, cancer, diabetes, depression and heart disease. She lives alone in a high-rise building in downtown. She has master’s degree in literature. She is a smoker and occasionally drinks alcohol with friends at party. There is no history of drugs abuse. No sexual history available. There is no history of surgery or hospitalization available. Patient was observed to have an intense craving for ice water at the time of first admission in ER last night. She denied any change in her appetite in the ER. She is not taking any prescription medications. She also denied the use of any herbs or over the counter medicines, other than Tylenol for headaches occasionally or for menstrual pain.

Gravida 0, Para 0. LMP March 12. Ht: 5’6” wt 135lbs but has lost about 6lbs in the last two weeks.

She is moderately dehydrated, BP 95/60, pulse 130/min, T 98.6F (37C), mental status drowsy but conscious.

1.) Identify the possible causes of her condition.

2.) What is the normal volume of urine per day in adults?

3.) Normally, how much daily fluid intake will be necessary for her to stay in fluid balance?

4.) If you are the person who is examining the patient what other physical findings do you think will be most obvious?

5.) Do you expect her blood report to show anemia?

6.) What lab tests would you think to have it done on this patient at this time to see her physiological state? (don’t say blood test or urine test but be specific)

7.) Which hormone and from where it is released that helps in reabsorption of sodium from the glomerular filtrate? What is the name of the condition of increased or decreased release of the hormone in question?

8.) If a patient is having low blood pressure, patchy pigmentation on the skin, hyponatremia and hyperkalemia, normal pituitary hormones of all kind, is most probably suffering from which condition?

9.) Which hormone and from where the hormone is released that helps in reabsorption of water from the glomerular filtrate in the DCT? What is the name of the condition of increased or decreased release of that hormone?

10.) Which hormone is responsible for Latanya’s condition and does Latanya has diabetes mellitus or not?

Answer 1

1. Answer:- The possible causes of her condition is Diabetes mellitus, because she have symptoms like
           - Polyuria (increase urination)
           - Polydipsia (excessive thirst)
           - Easy fatigue

2. Answer:- The normal range of pee day of urine is about 800 ml to 2,000 ml (with a normal fluid intake of about 2 litres).

3. Answer:- Daily fluid intake (RDI) for water is 3.7 litres.

4. Answer:- Other physical findings will be polyphagia, weight loss, easy fatigue, blood glucose level.

5. Answer:- Anemia is not necessary in diabetic patients, there is increased blood glucose level than normal.