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Case Problem #3 Case Problem #4 History: A 54-year-old male presented to the emergency department with sudden onset of acute upper central abdominal pain radiating to his back. The pain began shortly after breakfast and he vomited several History: times without relief from his pain. A previously healthy 32-year-old female presented with prolonged spontaneous breathing recovery after general anesthesia that included succinylcholine. The patient was sent to the intensive care unit (ICU) Medical History: The patient's medical history was significant for hypertension, pre-diabetes, and moderate and intubated for mechanical ventilator support. The next day the tracheal tube was removed without alcohol intake, but non-smoker. He has a family history of cholestasis. His sister had cholelithiasis 2 years complications and patient's spontaneous respiration resumed. The patient was discharged the following ago. His mother and brother had cholecystectomy 15 years ago and 6 years ago, respectively. day. As part of the physician's investigation of the patient's prolonged spontaneous breathing recovery Physical Examination: The patient was found to have a temperature (100.6 F), blood pressure 112/62 following anesthesia, a serum cholinesterase was ordered and specimen drawn before discharge. mmHg, respiration rate 24/minute, and pain was 8 out of 10. Lungs were clear and equal bilaterally. Abdomen was tender in mid-epigastrium with guarding and rebound tenderness. Physician ordered CBC, Laboratory Data: CMP, serum lipase amylase, CRP, and serum troponin. Serum cholinesterase (PCHE) 52 U/L (RI: 4260-11,250 U/L Female) Laboratory Data: Questions: Comprehensive Metabolic Panel (CMP) 1. Based on the patient's history and laboratory result, what is the reason for the prolonged spontaneous Sodium 144 mmol/L breathing recovery? Potassium 4.1 mmol/L Chloride 106 mmol/L Bicarbonate 25 mmol/L BUN 16 mg/dL GENERAL QUESTIONS Creatinine 0.8 mg/dl Glucose, fasting 121 mg/dL (RI: 70-99 mg/dL) 8.9 mg/dL 1. For the serum cholinesterase enzyme assay described in lecture, what is the composition of the Calcium Protein, total 7.5 g/dl reagent? Albumin 4.8 g/dL Serum lipase 320 U/L ALP 65 U/L Serum amylase 170 U/L ALT 19 U/I CRP 12,000 ng/mL (RI: 100-8,800 ng/mL) AST 15 U/L Serum troponin 18 ng/L ( 52 ng/dL ULN) Bilirubin, total 0.6 mg/dL 2. What are the major sources of serum cholinesterase? Questions: 1. Review the patient's CMP results. Identify abnormal finding(s). 2. Review the patient's serum lipase and serum amylase results. What is your interpretation of these results? 3. Review the patient's CRP result. What is the significance of this result? 4. Review the patient's serum troponin result. Why did the physician order this test? 5. Based on the patient's history and laboratory results, what is the most likely diagnosis? GENERAL QUESTION 1. Regarding the amylase assay, why isn't the EDTA collection tube an acceptable choice? Be specific. 2. Regarding the lipase assay, why is a fasting specimen required? Be specific