to release of K+ from damaged tissues. The low HCO 3 – reflects the metabolic
acidosis that is a feature of acute renal failure.
DISCUSSION OF CASE STUDY 8.2
Arnie suffers from hypomagnesemia. The low serum K+may reflect its loss in
diarrhea. Arnold presents with symptoms typical of hypocalcemia even though
his total serum Ca2+ is normal. Patients with symptoms of hypocalcemia, but
normal serum Ca 2+, should be investigated for hypomagnesemia. Arnold was
treated with magnesium supplements given parenterally rather than orally
because of his diarrhea and his symptoms resolved.
DISCUSSION OF CASE STUDY 8.3
John presents with nocturnal, acute, severe pain in the large toe together
with signs of inflammation: all classical features of gout. The finding of
hyperuricemia supports this diagnosis. However, some patients with gout
have a normal serum urate concentration. The toe joint should be aspirated
and examined for urate crystals. The aspirate should also be examined in
a microbiology laboratory to exclude the possibility of an infection. John
should be treated with indomethacin until his symptoms resolve. He should
be advised to reduce his dietary intake of protein and alcohol.
CHAPTER 9
DISCUSSION OF CASE STUDY 9.1
John is suffering from a partially compensated metabolic alkalosis. The
low blood H+ concentration indicates an alkalosis while the high HCO 3 – is
indicative of metabolic alkalosis. This alkalosis is associated with a loss of
acid from the stomach by vomiting, hence the dyspepsia. John will have
involuntarily reduced his ventilation rate to correct the alkalosis by increasing
bloodPCO 2 and so there has been a partial respiratory compensation.
DISCUSSION OF CASE STUDY 9.2
Tom’s low [H+] indicates alkalosis. Given the low PCO 2 , this is a respiratory
alkalosis probably caused by his asthmatic attack. The HCO 3 – is still within
the reference range so the condition is uncompensated. This is consistent
with the slow nature of renal compensation.
DISCUSSION OF CASE STUDY 9.3
Terry has a high H+which is indicative of an acidosis. The patient has a low
HCO 3 – which is indicative of a metabolic acidosis. His body has attempted to
correct the acidosis by respiratory compensation causing hyperventilation
leading to a reduced PCO 2. Thus Terry has a partially compensated metabolic
acidosis.
CHAPTER 10
DISCUSSION OF CASE STUDY 10.1
Andrew is obese with a BMI of 31.72 kg m–2. Health risks of obesity include
heart disease, hypertension and type 2 diabetes (Figure 10.25 and Table
10.7). His total cholesterol concentration is acceptable but not desirable. The
triacylglycerol concentration is increased while the HDL concentration is
low, increasing the risk of heart disease. His blood pressure is also relatively
high. Since Andrew has a family history of heart disease, he would be strongly
CHAPTER 10CZhhVg6]bZY!BVjgZZc9Vlhdc!8]g^hHb^i]:YLddY (