Victoria and Rusty were worried about their infant Bailey since his first trip
to  the  hospital  at  3  weeks  of  age.  At  that  time,  he  had  a  temperature  of
103°F  and  a  runny  nose.  The  emergency  department  physician  examined
the  infant,  but  determined  the  child  was  suffering  from  a  common  cold,
probably  brought  home  by  his  older  siblings,  and  that  all  would  be  fine.
Since  then  Bailey's  health  has  not  improved  and  he  has  experienced  an
unusual  number  of  bacterial  infections.  The  antibiotics  that  Bailey's
pediatrician prescribed have cleared up the bacterial respiratory infections,
but the infection seems to recur.
Bailey is now back at the hospital with pneumonia and his physician
has  ordered  a  number  of  laboratory  tests  as  he  is  now  worried  about
Bailey's immune system. The studies show that Bailey has normal levels of
B cells and T cells, with his immunoglobulin levels and hematology results
listed in Case Study

EG, a 13 year old teenager from Redondo Beach, CA and his parents were vacationing in the French Alps atop the famous Col de la Madeleine located 6,539 ft. above sea level (more than 1,000 ft. above Denver where water boils at 93.1'C), EG decided to make breakfast for his parents using the same techniques from home. He prepared buttered toast, two hard-boiled eggs that were cooked for four minutes each, and a half cup of cottage cheese topped with three pear slices. Later that evening, his parents show the following symptoms: fever, headache, abdominal cramps, nausea, vomiting, and muscle cramps. The next morning they were also experiencing bloody diarrhea and decided to visit the local emergency room. The ced that they were experiencing a bacterial infection and asked about their activities to better understand the source of the infection. Questions: 1. What is the elevation in Redondo Beach, CA? 2. At what temperature does water boil in Redondo Beach, CA? 3. At what temperature does water boil in Col de la Madeleine? 4. What is the most likely bacterial that caused their infection based on the information above? 5. How did EG's parents become infected with this bacteria?

Causes of Abnormal Plasma Urea Concentration HAPTER 12 Nonprotein Nitrogen Compounds Congestive heart falure Shock, hemorrhage Dehydration Increased protein cataboliom High-protein diet Acute and chronic renal failure Renal disease, including glo- CASE STUDY TABLE 12.1.1 Laboratory Reis- First Admission Urea N (Img/d) Creatinine (mg/dl) 1.8 13 Urea N/creatinine 25 Renal merular nephritis and tubular 18.5 122 7.50 48.7 Urinary tract obstruction 744 Decreased Concentration Low protein intake Severe vomiting and diarrhea Liver disease pO, (mm Hg o,sat (%) 328 576 51.391.0 protein cin catabolism, such as occurs in stress, fever, major diuresis. This treatment brought about a illness, corticosteroid Because of severe respiratory distress, the patient was transferred to the intensive care unit, placed on a respirator and given diuretics and intravenous (IV) fluids to promote d therapy, and Gl hemorrhage, may signiśicamt increase the urea concentration. Decreased urea concentration as a result of compromised urea excre- ed renal function causes an increase in plasma improvement in both cardiac output and renal function. as shown by laboratory results several days later (6/3).After 2 additional days on a respirator with IV therapy, the patik of elevated urea include acute anbere within normal limits (67), renal function had returned to normal and, at discharge, his dmitted 6 months later because of intrinsic renal disease (see Chapter 27). Postrenala temia can be due to obstruction of urine flow anywhere in the urinary tract by renal calculi, tumors of the bladder or prostate, or severe infection. increasing inability of his family to arouse him. On admis sion, he was shown to have a tremendously enlarged heart with severe pulmonary disease, heart failure, and prob- able renal failure. Laboratory studies on admission were The major causes of decreased plasma urea concen- as shown in Case Study Table 12.1.2. Numerous attempts tration include low protein intake and severe liver dis- were made to improve the patient's cardiac and pulmonary ease. Plasma urea concentration is decreased during late f pregnancy and in infancy as a result of increased protein synthesis. The conditions affecting plasma urea concentra function, all to no avail, and the patient died 4 days later Differentiation of the cause of abnormal urea concentration CASE STUDY TABLE 12.1.2 Laboratory Results is aided by calculation of the urea nitrogen/creatinine (urea Second Admission N/creatinine) ratio, which is normally 10:1 to 20:1. Prerenal conditions tend to elevate plasma urea, whereas plasma creati- nine remains normal, causing a high urea N/creatinine ratio. A high urea N/creatinine ratio with an elevated creatinine is Uric acid (mg/dl) usually seen in postrenal conditions. A low urea N/creatinine Urea N/creatinine ratio is observed in conditions associated with decreased urea production, such as low protein intake, acute tubular necrosis, pH tion are summarized in Table 12.3. 90 Urea N (mg/dl) 3.9 12.0 23 7.35 59.9 pCO: (mm Hg) pO, (mm Hg) O, sat (96) 34.6 and severe liver disease. 63.7 CASE STUDY 12.1 e chronic obstructive lung disease, renal insufficiency, 1. What is the most likely cause of the patient's clevated and 65-year-old man was first admitted for treatment urea nitrogen? Which data support your conclusion t laboratory data on au significant cardiomegaly. Pertinent (5/31) are shown in Case Study Table 12.1.1.

uestions 7. In the colorimetric determination of cholesterol the enzyme cholesterol oxidase, the agent that oxidi the colorless organic compound 4-aminoantipyrine a pink complex is a. Hydrogen peroxide b·Cholest-4-ene-3-one . Which of the following methods for lipoprotein elec- trophoresis depends on charge and molecular size? b. Paper c. Cellulose acetate d. Agarose d. Phenol 2. Which of the following statements concerning chylomi- crons is FALSE? a. The major lipid transported by this lipoprotein is 8. Which lipoprotein is the major carrier of cholesterol to peripheral tissue? a. LDL b. Chylomicrons c. VLDL d. HDL cholesterol. b. This lipoprotein is produced in the intestinal c. The primary function is to carry dietary (exog d. It remains at the origin (point of application) dur- mucosa enous) lipids to the liver. ing lipoprotein electrophoresis. 9. True or false? Increased levels of apo A-I are associ- ated with increased risk of CAD 3. The lipoprotein that contains the greatest amount of protein is called a. HDL 10. A patient is admitted to the hospital with intense chest pains. The patient's primary care physician requests the emergency department doctor to orde several tests, including a lipid profile with chol fractionation.Given the patient's results below, what would be the LDL-C for this patient c. VLDL d. LDL 4. True or False? Pre-beta (VLDL)-lipoproteins migrate Total cholesterol- 400 mg/dL; triglycerides further toward the anode on polyacrylamide gel than HDLC - 100 mg/di LP electrophoresis, pending they do on cellulose acetate or agarose a. 240 mg/dL b. 160 mg/dL c. 200 mg/dL d. 300 mg/dL 5. Several enzymatic triglyceride methods measure the production or consumption of a. NADH b. Fatty acids c. Glycerol d. Diacetyl lutidine 11. A patient is admitted to the hospital wit chest pains. The patient's primry requests the emergency 6. The most likely cause for serum/plasma to appear several tests, including a lipid protile fractionation. Given the patient's resu below, what would be this patient s a "milky" is the presence of LDL-Cstatus 3u b. VLDL c. LDL d. HDL Total cholesterol 400 mg/dL; HDL-C = 100 mg/dL; LP electrop a. High b. Optimal c. Desirable d. Borderline