Office hours (2)

Formation of practical skills on the theme “Disorders of water and electrolyte metabolism”

The purpose of the office hour:

• Development of practical skills of interpretation of clinical and laboratory data in solving clinical cases

Tasks of study:
• To apply the theoretical knowledge in pathophysiological analysis of cases

The Method of office hour: case study
Case Study

Case 1

Examination of a 32-year-old patient showed various signs of pathology, including excessive body mass: his height was 168 cm, and weight 84.5 kg. The patient also had a pasty face, and periorbital puffiness; his skin was pale; he had slow rebound of tissue to its original contour after pressing the feet or shin with the fingertip. The patient told the physician about tightness of a ring and shoes in the evening. An investigation of the cardiovascular system revealed the following: minor arterial hypotension, areas of cardiac dullness are slightly increased; other parameters are unremarkable. The daily urine volume is within the normal range.

Questions:

What is the possible cause of the patient's excess of body mass?

Can we state that water-ionic balance is deranged in this patient?

What type of edema is observed in the patient?

What additional data are required to specify the type of edema in this case?

Case 2

A 42-year-old patient has been admitted to hospital with a diagnosis of "uncompensated myocardiodystrophy". The patient has a normal constitution with paucity of subcutaneous tissue. His height is 165 cm, body weight 81 kg. On examination: the patient needs to sit in bed; he has dyspnea, acrocyanosis, marked lower extremities edema, rales and wheezes during auscultation of the chest. X-ray investigation of the abdominal area shows an accumulation of fluid; the liver is enlarged; stroke volume and cardiac output are decreased; hematocrit 38%; daily urine volume is decreased. Biochemical tests reveal increased plasma activity of renin and increased sodium concentration.

Questions:

Are there any signs of derangement of water balance in this patient?

What type of dyshydria is observed in this case?

Is there any association between the accumulation of fluid in the subcutaneous tissue, the abdomen, and the lungs?

4. Explain the pathogenesis of increased blood levels of renin and Na⁺ in this patient.

Explain the pathogenesis of edema in this patient.

Explain the role of edema in deterioration of the patient's condition.

What therapeutic approaches can be used to treat the edema in this case?

Case 3

A 22-year-old patient who experienced severe scarlet fever 2 weeks ago complains of headache, pain in the back, dyspnea, and palpitations. During the last week she has increased her body weight by 11.5 kg. On examination: her face is pale; she has periorbital puffiness, and edema of the shins and feet; the boundaries of the heart dullness are increased; blood pressure is 180/100 mm Hg; daily urine volume is reduced. Urine tests show the presence of erythrocytes and protein. An increased titer of streptococcal antibodies is found in the blood.

Questions: