How would one answer the following questions based on the following patient scenario?
A 68-year-old male has a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon, it became difficult to manage his hypertension. He also lost his appetite and became weak, easily fatigued, and developed edematous around his ankles. Additionally, he has been having some difficulty with his attention span. He debated with his physician about starting dialysis, but she insisted that, before the signs and symptoms of uremia increased, the treatment was absolutely necessary.
Why is this patient fatigued?
Here are some of the patient's recent laboratory studies. What are the abnormals, and why might they be abnormal for him?
Hgb 9.9 g/dL
Na 137 mEq/L
K+ 6.2 mEq/L
HCO3- 19 mmol/L
BUN 38 mg/dL
Cr 2.5 mg/dL
Phosphate 5.9 mg/dL
Ca 8.0 mg/dL
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To complete your assignment, you'll want to think about the symptoms of hypertension and the other illnesses listed as well as any symptoms associated with the lab results below. As we are limited in space, below are a few ideas to help get you started.
Hypertension is high blood pressure. Those with hypertension are at risk for "stroke, aneurysm, heart failure, heart attack and kidney damage" (Cedars-Sinai, "High Blood Pressure"). High blood pressure can result in a number of symptoms if left untreated for a long period of time. Symptoms include, fatigue, headache, vomiting, nausea, restlessness, shortness of breath, and blurred vision ("High Blood Pressure"). Hence, as we can see, hypertension is one explanation out of probably several for the patient's fatigue.
Probably many of these lab results are normal and many are abnormal indicators of his symptoms. You'll need to continue looking up each result to finish completing your assignment. The white blood cell count of 6,500 cells/mcL is one result that is normal. For a male, the white blood cell count range should be between 3,500 and 10,500 cells/mcL (Mayo Clinic, "Tests and Procedures: Complete Blood Count (CBC)"). The white blood cell count is considered low at 1700 cells/mcL(MedlinePlus, "Low White Blood Cell Count and Cancer"). Hence, the patient's white blood cell count is normal and not a contributing factor for his fatigue.
One of the lab results that can be considered abnormal is his serum sodium (Na) concentration levels. A study was recently conducted to show that serum sodium concentration levels are a "useful predictor of mortality in patients with end-stage liver disease" (Biggins et al., "Evidence-Based Incorporation of Serum Sodium Concentration Into Meld"). The scientists conducted their study on 753 patients with end-stage liver disease and found that, out of those patients, the median score for Na levels was 137 milliEquivalents per liter, or mEq/L (Biggins et al., p. 1652). So, if our patient has an Na level of 137 mEq/L, then that's a good indication that he has end-stage liver disease, an abnormal lab reading, and could also explain his fatigue in part.
Another slightly abnormal lab result is the K+6.2 mEq/L. This reading refers to potassium levels. We call high potassium levels hyperkalemia. Potassium is critical for muscle movement, particularly for maintaining normal heart rhythm (emedicinehealth, "Hyperkalemia (High Blood Potassium)"; "Anemia," p. 141). Normal potassium levels are considered at 3.5-5.0 mEq/L. The range of 6.1-7.0 mEq/L is considered the range for diagnosing moderate hyperkalemia, so our patient at 6.2 mEq/L has moderate hyperkalemia. Symptoms of muscle weakness and tiredness are two common symptoms of hypekalemia; therefore, moderate hyperkalemia can also be contributing to the patient's fatigue.
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