Case
- Persistent headaches, feet swelling, "problem with my urine"
Hints page 1
I. The Case (& preliminary "hints")
Case - Persistent headaches, feet swelling, "problem with my urine".
II. The Chart
We examine the information revealed in HUMAN by selecting < Your Patient's Chart > ...
We note that several of the vital signs are in the abnormal range. These include marked hypertension (166/123 mm Hg) and a high body weight (93.6 Kg).
We also note there are verbal reports of persistent headaches, a "problem with my feet swelling" and "a problem with my urine".
[We might well decide to change this patients name to L. D. Lipo to make him more current!]
III. Output data - Focusing on renal issues
This is a somewhat complex case having at least two major components. The most pressing, possible renal difficulties ["problem with my urine"] will be the focus of this hints page.
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), glomerular filtration rate, blood urea nitrogen, excretion of urea (mg/min), excretion of water (ml/min) and excretion of protein (EXPR, grams/min).
A-2] Choosing Charts and Tests to display
Charts: We request a <Patient chart..> that shows a Kidney Summary. (see immediately below)
B] Results:
We now run the model for 0 min. with 0 min. between printouts to observe a renal snapshot of the current case.B-1] Pattern of the physiological variables
Some items in the above data to think upon here include
• what do the blood urea nitrogen and kidney urea excretion patterns suggest about renal function?
• is this a normal protein excretion level?
• flow through the kidney
- is the glomerular filtration rate normal here?
- are levels of water excretion high? low?
We have also requested a Kidney Summary chart (below) and might compare this 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?
• Are the values for Renal Blood Flow and Renal perfusion Pressure normal?
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 first hints section on this case. While a second hints page is available (see below) the data on this page are those that deal with the primary diagnosis while page 2 deals with a somewhat related but separate aspect of the 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. Further HInts
A second hints page is available that deals with a related but somewhat less core issue of this case. [ hint page 2 ]
VI. 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.
