Case - Back pains, shivering, "problem with my urine";
Run me for 10 more days.
Hints page

I. The Case (& preliminary "hints")

Case - Back pains, shivering, "problem with my urine"; Run me for 10 more days.

II. The Chart

We examine the information revealed in HUMAN by selecting < Your Patient's Chart > ...

... noting that while the vital signs are largely within normal range there are reports of back pains and shivering coupled with a statement of a "problem with my urine. "

... we are also explicitly instructed to run this patient for ten more days (presumably to more clearly see the developing pattern of problems).

III. Running the patient for 10 days to obtain a fuller data set

A] Setup:

The report of urinary problems leads us to focus on renal function. To do so we choose output variables and tests that yield information targeted to renal function.

A-1] Choosing output variables to display

Variables: Change View output: to show a selection of renal-related variables, (see below) especially those that will not show up readily on <Patient Charts or Lab tests>.

These are, left to right, mean arterial pressure (AP), blood urea nitrogen, excretion of urea (mg/min), an acid-base profile [ blood arterial pH, plasma BICARBonate and total lung ventilation.

A-2] Choosing Charts and Tests to display

Charts: We request <Patient chart..> that shows a Kidney Summary. (see immediately below)

B] Results:

We now run the model for 10 days (10d) with 1 day (1d) between printouts to observe developing trends.

B-1] Pattern of the physiological variables

Some trends in the above data to think upon here include

• what do the blood urea nitrogen and kidney urea excretion patterns suggest about renal function?

• what do the pH, bicarbonate and ventilation patterns suggest about the acid/base situation and therefore renal function?

We also now run and compare the Kidney Summary chart at day 10 with that of a "normal" subject (run a Physiological experiment to obtain Mr. Norm L. Subject's Kidney chart).

B-2] Patterns in the patient's kidney chart

Some items in the above data to think upon include

• Is this a normal Glomerular Filtration Rate (GFR) and if not, what consequences might this have for renal function?

• Are the rates of water excretion (EXH2O) and urea excretion (EXUR) normal?

• Does protein normally appear in the urine in these amounts?

• Acid handling- are these normal values for renal acid excretion rate and urine pH?

C] Another approach - obtain urine samples

Note that a somewhat different approach can be taken to characterizing possible renal problems by asking for kidney data via urine samples. While we do not do so here, how to do so is illustrated briefly below.

- ask for a 24 urine collection (set up left, request on the right)

or

- ask for a series of urine specimens (below)

IV. More

This ends the hints section on this case.

You should attempt again at this point to arrive at a diagnosis and a treatment. To do so

• Return to the HUMAN model's Physiology Lab section for this patient and verify

- the diagnosis by finding the appropriate variables to support your argument and

- the treatment by changing parameters so as to stabilize the patient.

V. Analysis

If you wish further analysis and a diagnosis on this case and information on how it was created, click on this link ( analysis ) and log in as requested.

* Note: Case hints and analyses are based heavily on Drs. Randall and Coleman's HUMAN-80 Instructor's Manual supplemented by notes of Dr. Coleman's in the model code itself and findings by myself and other colleagues over our years of use of these cases.