Question

Case-2:
A 55-year-old male, presented with chest heaviness, increased frequency of urination with the history of hypertension. His lifestyle is very sedentary and in physical examination he showed to be obese (height 165 cm, weight 102 kg, BMI of 37.5 kg/m2). Biochemistry results are as follows:

Plasma	Results	Reference Intervals
Sodium	128 mmol/L	(135-154)
Potassium	5.0 mmol/L	(3.5-4.5)
Chloride	91 mmol/L	(95-108)
Urea	31.2 mmol/L	(3.0-8.0)
Creatinine	2.8 mmol/L	(0.05-0.12)
Glucose	12.1 mmol/L	(3.5-6.4)
Triglyceride	3.5 mmol/L	(<2.0)
Total-Chol	7.2 mmol/L	(<4.0)
LDL-Chol	3.5 mmol/L	(<2.0)
HDL-Chol	0.4 mmol/L	(>1.0)
AST	65 U/L	(5-35)
ALT	70 U/L	(5-40)

Urine screening
Glucose (++)
Micro-albumin (trace)

1. Interpret the pathology results and suggest a provisional diagnosis.
2. Discuss the clinical presentation of this case &relate it to the laboratory findings and interpretations.
3. What are the other clinical impacts related to this condition?
4. What are the risk factors contributing to the patient pathologic condition?
5. What other pathology tests would you suggest supporting the provisional diagnosis.

Answer 1

1.he is having albuminuria as well as impaired renal function test, he is also having elevated blood sugar as well as glucosuria, the provisional diagnosis is Diabetic nephropathy with probable myocardial infarction and hypertension.

2. He presented with chest heaviness and increased frequency of urination, the chest heaviness may be due to complication of diabetes either angina or myocardial infarction .

3.Clinical impacts it can lead to diabetic retinopathy, diabetic neuropathy, muscle wasting and diabetic nephropathy,  

4.risk factors are the

sedentary lifestyle

obesity

overweight

5. 1.all 12 leads ECG is required ( to find out any ST changes)

2 Echo to see the functioning of the heart chambers and the valve function.

3.Urine acetone to find out whether the patient has gone for diabetic ketoacidosis

4 Urine routine examination for any pus cells or urinary casts