Case - Overweight, some edema
Hints page 2
I. The Case (& preliminary "hints")
Case - Overweight, some edema
II. Further testing of cardiovascular status
Already having observed signs of cardiac compromise (hints page 1), we test cardiovascular status explicitly via the HUMAN exercise tolerance test..
A] To run the standardized exercise tolerance test (see main Patient page- bottom for protocol), we run the standard 3.0 L/min. O2 use exercise expecting 11 min. until exercise cessation at O2 debt of >10 L total. We also ask for < Your Patient's Chart >.
• we obtain our results, running with our previous( hints page 1) cardiovascular output tables
• we observe the results of the exercise test on our CV variables
• and in particular (below) we notice below on < Your Patient's Chart > that the patient's time to exercise cessation has dropped from the standard 11 min. to 7 min. and his report of the difficulties he encountered.
B] You may wish at this point to see if digitalization improves cardiac performance and if diuretics help with the somewhat elevated blood volume (BV or use Chart ... Volumes Summary).
III. Testing for possible renal failure involvement
Concomitant blood works yields blood urea nitrogen (BUN) values suggestive of possible renal failure.
We therefore run a renal function profile.
A] To obtain a renal function profile
• we set up our output tables to read out several critical renal variables
These are, left to right, blood urea nitrogen (BUN), glomerular filtration rate, water excretion rate (aka urine volume), sodium excretion rate, urine pH and, as a vascular volumes indicator, blood volume (BV).
• we observe the results of asking for this profile of renal values (below)
noting
- the high blood urea nitrogen (normal 15.0 mg-N/dl)
- marked low filtration rate (baseline 125 ml./min.)
- sharply lowered water excretion (and urine volume); normal ≈ 1.0 ml./min.
- very now Na+ excretion (expected baseline - 0.118 meq/min) and
- a somewhat increased blood volume (normal - 5.0 Liters)
B] Some of this same information could be obtained by either one of two alternate procedures
1] asking for a <Kidney summary> under Charts ...
this yields (below)
2] asking for a Urine sample under Charts .. . This yields (below)
Note that it is even possible to perform a 24 hour urine collection (not shown).
This ends the hints section, part 2, on this case.
You should attempt again at this point to arrive at a diagnosis and, where possible, 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.
