# Dale is 55 year old man who has been feeling ill over the last week. He...

###### Question:

Dale is 55 year old man who has been feeling ill over the last week. He has had episodes of vomiting and sweating. He assumes that he is suffering from the stomach flu that his grandchildren had two weeks ago. After not being able to “kick” the bug, he sees his family physician. The only other symptom he reports is a pulled muscle in his chest while shoveling snow about a week ago. Below are his chemistry results.

 NA+ 139 mmol/L AST 70 U/L K+ 3.8 mmol/L ALT 49 U/L Cl- 104 mmol/L CK 502 U/L CO2 23 mmol/L LD 365 U/L Calcium 10.0 mg/dL ALP 72 U/L Phosphorus 3.9 mg/dL Cholesterol 178 mg/dL Glucose 105 mg/dL HDL 19 mg/dL BUN 24mg/dL Triglycerides 424 mg/dL Creatinine 0.9 mg/dL

Questions:

1. What laboratory tests are abnormal? BUN, glucose, AST, CK and triglycerides are increased and HDL is decreased
2. What other tests would be beneficial in the diagnosis of this patient?
3. Can we determine if this patient has had an AMI? Why or why not?
4. What were some factors that would increase Dale’s risk of an AMI?

Part III:

Samuel is a 38-year-old male gardener. He visited his family physician because of skin lesions on his hands that began as mild erythematous changes which developed into painful blisters. The blisters first began erupting during the late spring months. The patient indicated no history of allergic contact dermatitis or other drug or food allergies. The patient consumed about 3-4 12 oz. bottles of beer daily. He showed signs of facial hyperpigmentation with some scarring predominantly in regions of the forehead.

 Na+ 136 mmol/L K+ 4.5 mmol/L Cl- 102 mmol/L HCO3- 26 mmol/L Glucose 163 mg/dL BUN 13 mg/dL AST 115 U/L ALT 154 U/L ALP 176 U/L

Questions:

1. What clinical symptoms suggest porphyria is present in this patient?
2. What lab data are consistent with a presumptive diagnosis of porphyria?
3. What is the most likely type of porphyria present in this patient? Why?
4. What additional lab data would be helpful in confirming the diagnosis?

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