A 54-year-old woman comes to the emergency department due to several hours of severe epigastric abdominal pain. The patient began having mild colicky upper abdominal pain after dinner last night and took acetaminophen before going to bed. In the night, the patient awoke with severe abdominal pain radiating to her back. She has also had nausea and several episodes of vomiting. The patient has a history of occasional upper abdominal pain after eating but has never had such severe symptoms. She has no other medical issues and takes no medications. Temperature is 37.6 C (99.6 F) , blood pressure is 110/66 mm Hg, pulse is 118/min, and respirations are 24/min. The patient appears to be in moderate distress. Mucous membranes are dry. The abdomen is distended with marked epigastric tenderness. Bowel sounds are decreased. Laboratory results are as follows: Which of the following sets of renal findings are most expected in this patient?

Question

A 54-year-old woman comes to the emergency department due to several hours of severe epigastric abdominal pain. The patient began having mild colicky upper abdominal pain after dinner last night and took acetaminophen before going to bed. In the night, the patient awoke with severe abdominal pain radiating to her back. She has also had nausea and several episodes of vomiting. The patient has a history of occasional upper abdominal pain after eating but has never had such severe symptoms. She has no other medical issues and takes no medications. Temperature is 37.6 C (99.6 F) , blood pressure is 110/66 mm Hg, pulse is 118/min, and respirations are 24/min. The patient appears to be in moderate distress. Mucous membranes are dry. The abdomen is distended with marked epigastric tenderness. Bowel sounds are decreased. Laboratory results are as follows:

Which of the following sets of renal findings are most expected in this patient?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d4f3_1591_bc81_55d825795ac3_MD0003_00 This patient has a history of colicky abdominal pain after eating, which raises suspicion for gallstones. She then developed clinical manifestations (severe epigastric pain, vomiting, elevated lipase) consistent with acute gallstone pancreatitis. Patients with pancreatitis typically develop severe hypovolemia due to vomiting, inability to tolerate oral fluids, and third-space extravasation. Manifestations include dry mucous membranes, hemoconcentration, tachycardia, hypotension, and/or shock. The kidneys respond by releasing renin from the juxtaglomerular cells. Renin converts angiotensinogen to angiotensin I, which is then converted into angiotensin II by ACE. Angiotensin II has the following systemic effects: Vasoconstriction: Increases efferent and systemic arteriolar resistance, which improves glomerular filtration rate and blood pressure Sodium and water reabsorption: Directly increases proximal tubule sodium reabsorption Aldosterone secretion: Increases sodium and water reabsorption in the distal tubule Therefore, this patient is likely to have increased renin, efferent arteriolar resistance, and tubular sodium reabsorption. Educational objective: Hypovolemia stimulates the renin-angiotensin system, which helps improve intravascular volume, glomerular filtration rate, and blood pressure via vasoconstriction and kidney-mediated sodium and water reabsorption. References: Fluid resuscitation in acute pancreatitis. (http://www.ncbi.nlm.nih.gov/pubmed/25561779)

A 54-Year-Old Woman Comes to the Emergency Department Due to Several