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Mr. X is a 34y/o Hispanic male who presented to the emergency room for a fatigue, dyspnea and chest pain which started yesterday morning. He has been experiencing some nausea, vomiting, and reports that he is needs dialysis.

Case Study #1

Mr. X is a 34y/o Hispanic male who presented to the emergency room for a fatigue, dyspnea and chest pain which started yesterday morning. He has been experiencing some nausea, vomiting, and reports that he is needs dialysis. He was diagnosed with chronic kidney disease 4 years ago and HIV 5 years ago. He is currently taking antiretroviral therapy for his HIV infection and reports compliance. He was last seen at a free clinic for his HIV care 2 weeks ago and does not know his current CD4 count or viral load. He has been receiving compassionate dialysis for 8 months and no longer produces urine. He was last dialyzed 5 days ago. His past medical history is significant for HIV, Chronic Kidney disease stage 5, Anemia, hypertension, pneumonia, hyperlipidemia

Past surgical history is positive for only a permacath placement 8 months ago.

Physical exam:

Vitals: 38.1-97-18-183/139

Normocephalic.

Alert & Oriented x3. Well developed.

Eyes: PERL. No nystagmus

Neck: Supple, no cervical lymphadenopathy

Cardiovascular: Normal Rate and rhythm. No murmur, gallops. 2+/4+ radial, brachial, dorsalis pedis pulses bilaterally. 2+ pitting edema of bilateral lower extremities.

Pulmonary: Dyspneic. Lungs are clear.

Abdomen: Soft and nontender, active bowel sounds. No peritoneal signs.

Skin: warm, dry and pale.

Rectal exam: stool is brown, no rectal masses

Lab Result
Sodium 133 mEq/L
Potassium 6.0 mEq/L
Creatinine 19.95 mg/dL
BUN 114 mg/dL
CO2 14 mEq/L
Anion gap 26 mEq/L
WBC 10,000
Hematocrit 25.4%
Hemoglobin 8.4 g/dL
MCV 85 fL
Platelets 154,000
Serum Iron 70 mcg/dL
Total Iron Binding Capacity 150 mcg/dL
Ferritin 450 ng/ml
Glucose 124 mg/dL

Questions

1. The clinical scenario is most consistent with which type of anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.

2. What data in the clinical scenario supports your diagnosis? You may simply list your answers below using bullet point format. This does not have to be in a complete sentence. A citation is not required.

3. What is the most likely cause of this patient’s anemia? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.

4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences. ***Citations are required for each answer to each question using APA format.

a. What is the electron transport chain and how is it altered by anemia?

b. Why is the ferritin level 450 ng/ml?

c. What effects does anemia/low blood volume have on the cardiovascular system?

d. What are the effects of tissue hypoxia on the cardiovascular system, pulmonary system and CNS?

e. How does chronic kidney disease cause anemia?

5. For what actual or potential complications related to the diagnosis in question 1 does he need to be monitored? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence. A citation is not required.

References:

McCance 201

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