A 52yearold man with a history of AIDS hypertension diabetes

A 52-year-old man with a history of AIDS, hypertension, diabetes mellitus, and alcohol abuse was found unconscious in his home by his roommate. In the emergency department, he was hypotensive (103/60 mm Hg), febrile (temperature 101 degree F), and unresponsive, Computed tomography scan of the abdomen showed cholecystitis and gallstones. Laboratory data listed The patient was diagnosed with acute renal failure. He was administered intravenous fluids: BUN fell to 68 mg/dL and creatinine fell to 2.2 mg/dL. The patient\'s blood culture report was positive for E coli. He was treated with tobramycin and cefepime. The patient continued to deteriorate and died 5 days after admission. Cause of death was multiorgan failure secondary to AIDS, sepsis, and alcoholic cirrhosis. What is the significance of the patient\'s elevated CK? Explain why the physician ordered a CK-MB and troponin level. What can you conclude about the patient\'s cardiac status? What is the cause of his acute renal failure? What is the significance of the patient\'s large urine hemoglobin? How would you interpret this patient\'s liver function tests considering his clinical history?

Solution

Answer:

1. The CK test is done to detect muscular inflammation in response to damage such as myopathies. Elevated CK-MB increases the suspicion of of Acute coronary disease or acute myocardial infarction.

In the patient, elevated CK may be attributed to renal failure and bacterial infection.

The 3 types (isozymes) of CK can be identified from the CK-MB test. CK-MB is found in cardiac muscles and is generally ordered in cases of heart attack.

The troponin level, more specifically Troponin-T or I is measured to detect a heart attack. Troponin T and I level increases in heart attack patients due to damage of the cardiac muscles. The troponin T level of the patient is in the normal range suggesting that he did not suffer from cardiac muscle damage or heart attack.

2. Escherichia coli infection is the probable cause of the acute renal failure in the patient.

3. Hemoglobin is generally not found in the urine but can be found in cases of glomerulonephritis and kidney infection. Large urine hemoglobin in the patient may be attributed to the Escherichia coli infection (probably Polynephritis).

4. The tests for liver function which has been performed with regard to the patient is aspartate aminotransferase test, bilirubin test, alanine aminotransferase test, alkaline phosphatase test and gamma glutamyl transpeptidase test.

The results of all these tests are above the normal range of the body denoting the damage to the liver, more specifically due to alcohol consumption.