Q@Q time ❻ - cardio69

[ArchivalUser]

An 17 y/o F brought to you by her mom . Mom believe her teen addicted to pot and tell you Doc “Yes my kid smoking pot”. Pat worsening weakness and problems with breading for las 13 days. Pat denies of use of any drugs and tell you doc; “I love ice cream since my childhood. She also states that had 4 or 5 UTIs in recent years which been treated with family dr. Pat not taking any med.

Lab/serum reveals;
Na: 138 mEq/L
K: 1.3 mEq/L
Cl: 118 mEq/L
HCO3: 12 mEq/L
Cr: 0.6 mg/dL
BUN: 22 mg/dL
Glucose: 90 mg/dL
ANA: +
Complement: Low
ABG;
pH: 7.2
pCO2: 26
HCO3: 11mEq/L

Lab/Urine;
pH: 6.6
Glucose: NEG
Blood: POS (had recent menstruation)
Ketones: NEG
Protein: 3/+
K: 100 mEq/L
Na: 60 mEq/L
Cl: 110 mEq/L
THC: NEG

Most likely cause of your pat symptoms?

a) Exacerbation of SLE
b) Distal RTA
c) Proximal RTA
d) Cannabis/Hashish use
e) Type IV RTA
f) Hypokalemic periodic paralysis

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[ArchivalUser]

Can this be SLE presenting as distal RTA? Just guessing. :S

[ArchivalUser]

What u pick if that was on real deal? (:

[ArchivalUser]

aaah the positive protein in urine, decrease complement levels and ANA positivity wants me to pick both.

[ArchivalUser]

SLE!!

[ArchivalUser]

Well pick one, Bz as real exam u got only one option to pick and Def mech not gone work. So YOUR ANS?

[ArchivalUser]

SLE. My final pick.

[ArchivalUser]

Is it C ???

[ArchivalUser]

B

[ArchivalUser]

Pat weakness & respiratory distress glue you to hypokalemia rather than *exacerbation of SLE. Although glomerular disease common in SLE, tubular paralysis is UNCOMMON in presence nomr renal function.
You would be right prior to dx SLE, hypokalemia relate clinical painting in the SLE cases
The serum & urine in pat direct you to distal RTA (hypochloremic/metabolic acidosis & alkaline urine pH despite acidosis) few cases some literature
True that immunoglobulin & distal nephron in lupus pat has been suggested. But Distal RTA best pick for what minimal info that been given to us is best pick in weakness & respiratory distress*.

So, *B* would be best to pick here.


@miacarmel I ask you Q u never reply back like yesterday thats why you still lack of understanding on your concept. TELL ME, On proximal renal tubular acidosis/typeII What's Urine pH?