Physio Freaks

[Junito]

TJ consumes a whole bag of potato chips (the very salty kind). What effect will this have on his ECF & ICF?
Will come up with more soon, have to call it a day.

[Junito]

Okay, want MC here goes, I got some help forming this question, A pt w/ a PaCO2 of 20 mm Hg (33-44 mm Hg) as compensation would most likely have a primary disorder arising from which of the following clinical disorders? a) Renal failure b) Gastritis w/ vomiting c) Pulmonary embolus d) Paralysis of the diaphragm e) Volume depletion secondary to diuretic use

[bchamp1281]

(A) b/c the patient has low acid levels and therefore must have lost too much through his kidneys b/c of its lack of function to reabsorb more (H+)

[SMUGrinch]

QC is a 13-year-old male is brought to your office with a cc of sore throat and malaise. He's due for an yearly physical. You notice he looks a little malnourished and has dry membranes; his eyes are sunken in and there's poor skin turgor. You ask his mother if he has been sick recently, she denies any recent illness, but states he sometimes complains of general muscle weakness. The mom admits that she had an eating disorder and so did her daughter.
You ask about his diet and she claims that he eats "like a horse" she also notes that he drink constantly and is in the bathroom all the time. In fact his teacher remarked that he is asking to go to the bathroom at least 4 times an hour. On PE you notice his BP is 136/72. You draw CMP,CBS w/diff.
Labs come back and you see that he has WBC of 14,000 with a left shift with 7% bands. Otherwise the CBC is unremarkable. ECG shows flattened T-wave and a U-wave. His CMP shows hypomagnesemia, hyponatremia and hypokalemia….This is a two part question:
What does this child have? Hint: think PHYSIO!!!!!!
a) Child abuse
b) Eating disorder
c) Genetic disorder (i.e. Bartter’s)
d) Septic infection
e) Muscle wasting syndrome
f) Diabetes insipidus (primary)
g) diuretic abuse
How do you treat this child?

[philenom]

I'm not a student yet so no grades okay. LOL . Just the correct answer will satisfy. It is an interesting scenario and the child has not seen the worst of things.
I think the answer is E) Muscle wasting syndrome. I can't remember the syndrome but the labs are normal for Glucose
but the electrolyted are screwy especially with hyponatremia. Maybe his sore throat is due to infection of parotid glands. EKG flat due to Hypokalemia. So what's the correct answer??

aloha

[Crazytrain-Rider]

My guess is an eating disorder such as bulemia. Vomiting would account for the sore throat,malise,dry membranes and frequent bathroom visits. The screwed up lab results could result from an eating disorder too.
This is purely a guess!!

[SMUGrinch]

The correct answer is NOT E.
I will not divuldge the correct answer in public until someone else tries, but if you PM me I will tell you the correct answer with an explanation.
That's a good guess though, this is a tough question. I like the fact that you know that a low K+ will give you that specific ecg change...also note that the same state will give you a U-wave...Parotid gland infections are rare and if the child does get it it's called mumps. There is also a disorder that affects others that have a parotid gland component to them it's called sjogrens syndrome. But be proud of yourself this was a great try.:) :)

[SMUGrinch]

My guess is an eating disorder such as bulemia. Vomiting would account for the sore throat,malise,dry membranes and frequent bathroom visits. The screwed up lab results could result from an eating disorder too.
This is purely a guess!!

Great try!!!! but that's not the correct answer if you PM me you will get the coorect answer...The eating disorder would be an ideal guess if this was a girl and I told you more of a history of normal childhood progressing to this. great try though
:) :) :)

[philenom]

It's 5:00 AM here in Hawaii. I know am dysthymic possibly in a manic phase right now. I hope to see you in Maine before you graduate.
I'll be starting in January 2006 and am reviewing Gross anatomy and Does it get worse??
So this is a fun kind of distraction.

Metabolic alkalosis is not usually due to an acute respiratory or vomiting response. I think the answer is one of long time diuretic use and reuptake of H+ ions in the kidneys. BBchamp might have hit it on the head also. but, the H+ ion response with renal failure may be more severe??

I pick answer: E) diuretic use over a long-term-use of the medication.

[SMUGrinch]

It's 5:00 AM here in Hawaii. I know am dysthymic possibly in a manic phase right now. I hope to see you in Maine before you graduate.
I'll be starting in January 2006 and am reviewing Gross anatomy and Does it get worse??
So this is a fun kind of distraction.

Metabolic alkalosis is not usually due to an acute respiratory or vomiting response. I think the answer is one of long time diuretic use and reuptake of H+ ions in the kidneys. BBchamp might have hit it on the head also. but, the H+ ion response with renal failure may be more severe??

I pick answer: E) diuretic use over a long-term-use of the medication.

I can see your the way you're thinking and it's on the right track. BUT, remember this is a child, what are the chances of him abusing diuretics...now if I told you this was an adult then diuretic abuse would be absolutely correct....
It does get harder my friends but I can promise you stick with it, don't get distracted by politics (ie read the rest of the board) and you will be fine.
:) :)

PS: try the pharm question...this is a very interseting phenemenon

[philenom]

I always recalled from fluid and electrolyted imbalance the simple rule of thumb that wherever Na goes so does water.
With the high intake of salty potato chips. The ECF increases as the increased Na will pull the fluids out at the celleular level into the interstitial space. Thusly, if this person is in CHF this kind of thing may put him over the edge resulting in pulmonary edema.

Have mercy! I haven't started school yet. I am struggling with pre-studying Anatomy. I give you guys a lot of credit for getting to the place you're at so far. Being 57, and working with a crystallized memory as the learning theorists state may prove to be more than a challenge and do me in. But better to have tried and failed than not to have tried at all.

Oh yeah, this patient's tongue will probably feel "fat" and may have a certain predictable appearance about it.

I am consistent and have been wrong on every case study so far. Laughing nervously and softly. LNAS.

thanks,

the old Hawaiian bat

[miasma]

is it bartter's syndrome? i'm not in smu yet, but i remember reading about this a while ago in undergrad.

[SMUGrinch]

is it bartter's syndrome? i'm not in smu yet, but i remember reading about this a while ago in undergrad.

Excellent...good job...now how would you treat it and why use that modality/
That's an excellent job, be very proud of yourself:D

[miasma]

tell patient to go on high potassium diet or something? i'm not sure... hopefully i can start smu soon so i can actually learn this stuff, instead of trying to remember my undergrad physio class, haha.

[SMUGrinch]

tell patient to go on high potassium diet or something? i'm not sure... hopefully i can start smu soon so i can actually learn this stuff, instead of trying to remember my undergrad physio class, haha.


Great stuff. That would be the basis of the modality...we wouold put him on a medication called spiranalactone to do exactly what you said, spare the potassium...great work miasma, outstanding.
:lol:

[philenom]

Hey Juni,

what's the verdict on the ECF ICF? I hope I get one answer correct.

As mentioned, I think there will be an increase in ICF as the conc. gradient will be high in the ECF. Or did I mentioned ECF.
Well, the gross rule of thumb phrase I recall from my ambulance attendant days was wherever Na goes so does water. ICF will be drawn out into the interstitium space.


What is the answer? I love Maui potatoe chips.

Aloha

[SMUGrinch]

I always recalled from fluid and electrolyted imbalance the simple rule of thumb that wherever Na goes so does water.
With the high intake of salty potato chips. The ECF increases as the increased Na will pull the fluids out at the celleular level into the interstitial space. Thusly, if this person is in CHF this kind of thing may put him over the edge resulting in pulmonary edema.

Have mercy! I haven't started school yet. I am struggling with pre-studying Anatomy. I give you guys a lot of credit for getting to the place you're at so far. Being 57, and working with a crystallized memory as the learning theorists state may prove to be more than a challenge and do me in. But better to have tried and failed than not to have tried at all.

Oh yeah, this patient's tongue will probably feel "fat" and may have a certain predictable appearance about it.

I am consistent and have been wrong on every case study so far. Laughing nervously and softly. LNAS.

thanks,

the old Hawaiian bat


The feeling fat part is generally with angioedema not just regular edema...
Everything else is correct thinking except for the pulmonary edema thing. You would have to also take into consideration their renal function as well, so they may not go into Pulmonary edema.
But my hawaiian friend you are on the right track and should be very proud of yourself.
Just as an aside make sure you get the difference between osmlarity (or osmolality) and tonicity.

[Junito]

Okay, want MC here goes, I got some help forming this question, A pt w/ a PaCO2 of 20 mm Hg (33-44 mm Hg) as compensation would most likely have a primary disorder arising from which of the following clinical disorders? a) Renal failure b) Gastritis w/ vomiting c) Pulmonary embolus d) Paralysis of the diaphragm e) Volume depletion secondary to diuretic use

The correct answer is A: Renal failure. The pt has a low PaCO2 (resp alkalosis), which must be compensation for metabolic acidosis as a primary disorder, which in this case is renal faiulure (increased anion gap metabolic acidosis). Vomiting and diuretics both produce primary metabolic alkalosis having respiratory acidosis as compensation. A pulmonary embolus is associated w/ tachypnea, which produces a primary respiratory alkalosis, whose compensation is metabolic acidosis. Paralysis of the diaphragm results in primary respiratory acidosis, which has metabolic alkalosis as compensation.

[Junito]

I always recalled from fluid and electrolyted imbalance the simple rule of thumb that wherever Na goes so does water.
With the high intake of salty potato chips. The ECF increases as the increased Na will pull the fluids out at the celleular level into the interstitial space. Thusly, if this person is in CHF this kind of thing may put him over the edge resulting in pulmonary edema.

Have mercy! I haven't started school yet. I am struggling with pre-studying Anatomy. I give you guys a lot of credit for getting to the place you're at so far. Being 57, and working with a crystallized memory as the learning theorists state may prove to be more than a challenge and do me in. But better to have tried and failed than not to have tried at all.

Oh yeah, this patient's tongue will probably feel "fat" and may have a certain predictable appearance about it.

I am consistent and have been wrong on every case study so far. Laughing nervously and softly. LNAS.

thanks,

the old Hawaiian bat

As SMUGrinch Stated you are correct...ECF wil expand, ICF will contract. Na concentrations will increase in the ECF causing the fluid from ICF move into the ECF.

[SMUGrinch]

Explain why a patient gets hyponatremia in diabetes (DKA)?

[bchamp1281]

In diabetes you lose sugar in the urine and can not store your fat in adipose. As a result you decrease the synthesis of ATP.

Low ATP levels = Decreased function of the NA+K ATP pump. If the pump doesnt push sodium back then it is lost in the urine b/c of the osmotic gradient; hence hyponatremia and hyperkalemia is seen in DKA

Hope this helps

[bchamp1281]

In diabetes you lose sugar in the urine and can not store your fat in adipose. As a result you decrease the synthesis of ATP.

Low ATP levels = Decreased function of the NA+K ATP pump. If the pump doesnt push sodium back then it is lost in the urine b/c of the osmotic gradient; hence hyponatremia and hyperkalemia is seen in DKA

Hope this helps

[SMUGrinch]

In diabetes you lose sugar in the urine and can not store your fat in adipose. As a result you decrease the synthesis of ATP.

Low ATP levels = Decreased function of the NA+K ATP pump. If the pump doesnt push sodium back then it is lost in the urine b/c of the osmotic gradient; hence hyponatremia and hyperkalemia is seen in DKA

Hope this helps

Thanks but I was asking to see if anyone could answer the question, this is one of those forums that you post questions to see if people can answer them. I would also have accepted dilutional hyponatremia and it's explanation.

[philenom]

What is the difference therein?

I had a great Fluid Electrolyte Text from nursing school....but lost it.

AS a sidenote: I don't know how you ladies and gentlement do the learning thing with soooo much information. I have been pre-studying for Anatomy; do we essentially have to memorize the entire text book?
I have Moore's. If so, I will be obtunded and may suffer cerebral microinfarcts.

Thanks for letting me know the one who started the SGA was around 50. Juni.

Aloha,

P

[Junito]

If you have the Big Moore book read the chapter review vignettes, that is what I did. Also the website from the Univ of Mich is great. Loyola has a great site also, but I prefer the Univ of Mich one. Read the blue boxes also.

Back to the topic...Physio :mad:

[unknownunknown]

TJ consumes a whole bag of potato chips (the very salty kind). What effect will this have on his ECF & ICF?
Will come up with more soon, have to call it a day.

What flag is that? not cuban, but close though

[Junito]

Puerto Rico...