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Cynthia, a 53-year-old female presented to the emergency room due to feeling constantly tired, hungry, thirsty, and with frequent urination. Her past medical history is significant for cirrhosis and end-stage kidney disease. Physical examination had revealed yellowish discoloration to the skin, multiple bruises, bilateral edema, and weakness lasting more than three weeks. Laboratory tests were ordered (results provided below) after which she was prescribed metformin and informed to contact a doctor if she starts experiencing nausea, vomiting, fast breathing, and/or lethargy, as metformin has been known to cause metabolic acidosis. Complete Blood Count (CBC) Sodium 126 mEq/L Glucose 220 mmol/L Calcium 7.1 mg/dl Red blood cell count 3.9 cells/ul Iron 40 mcg/dL Albumin 2.5 g/dl Vitals Blood pressure 92/64 mmHg Hormone Panel Renin Low ADH Elevated Aldosterone Low Vitamins Vit D Low Vit K Low Vit E Low Vit A Low Urine and Stool Sample Stool color Gray Stool content Increase fat content Urine color Clear Complete Blood Count (CBC) Glucose Present Answer the following questions regarding Cynthia’s case: What hormone is not functioning properly causing Cynthia’s glucose levels to be abnormal? Furthermore, explain in depth how this hormone regulates blood glucose levels. What other hormone(s) are responsible for maintaining normal glucose levels? Explain in depth how they work. Explain why Cynthia is presenting with excessive thirst (polydipsia), tiredness and hunger (polyphagia), and frequent urination (polyuria). Explain why Cynthia is experiencing hypotension. How does the body and its various organ systems bring the blood pressure back towards homeostasis? What do you expect Cynthia’s heart rate and end-diastolic volume (EDV) to be (elevated, normal, or low) and justify your expectation with cardiovascular formulas such as cardiac output (CO) and stroke volume (SV). What is the importance of iron in the body and the consequence of it being 40 mcg/dL? Explain in detail what gluconeogenesis is and where in the body it occurs? Knowing that gluconeogenesis helps maintain blood glucose level, what is the effect of metformin on the management of diabetes mellitus type 2? Looking at Cynthia’s albumin levels, what effect does it have on her (a) blood osmolarity (b) glomerular filtration rate (GFR) and (c) urine volume? Explain how glucose is normally reabsorbed by the kidneys? What is happening in Cynthia’s kidneys resulting in glucosuria and what effect does glucosuria have on her blood pressure? If Cynthia ends up developing metabolic acidosis, what would the levels of her pH, CO2, and HCO3 be in the blood? Furthermore, how would the body compensate and address both renal and respiratory compensation (optional: show the compensation via a flow chart)?
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