Goals “Something is wrong. My mother is sick and very disoriented,” explained Bobby Burroughs, a middle aged man who was looking very anxious as he

Goals “Something is wrong. My mother is sick and very disoriented,” explained Bobby Burroughs, a middle aged man who was looking very anxious as he spoke with staff in the Emergency Department (ED) where he had brought his mother, Arlene Burroughs, an 83-year-old white woman. “She’s disoriented and lethargic, and she has been vomiting and complaining of an upset stomach,” he said to the triage nurse who examined Mrs. Burroughs. The nurse noted that Mrs. Burroughs did not have a fever or any other signs of infection but that she did appear to be dehydrated. The attending physician in the ED ordered a battery of tests. “I’m especially concerned about her kidney function,” he told Bobby. “I don’t understand,” said Bobby. “Shouldn’t you be looking at her brain? That seems to be where the problem is! She is really confused—doesn’t that tell you that something is wrong with her brain function? if she’s had a stroke?!” “Well, she certainly may be having some problems, but her brain and nerves may be responding to changes that are produced by her kidneys,” the doctor explained. “Let’s get some more information so we’ll know where to look for the problem.” The results of these tests are provided in Table 1. Table 2 provides normal ranges of values for standard laboratory tests. Bobby handed the physician a paper bag with several bottles in it. “These were on Mom’s kitchen table,” he said. “I just don’t understand—she’s very good about taking her medicine.”In the bag is a bottle of hydrochlorothiazide (25mg), a prescription medicine used to lower blood pressure. The label on the bottle reads, “Take one capsule in the morning and one capsule in the evening.” “Mom calls these her ‘water pills.’ The doctor said they were diuretics and they lower her blood pressure. She used to complain that they made her need to use the restroom more often.” Also in the bag were a bottle of Tums® Ultra 1000mg (CaCO3) and Alka-Seltzer® (NaHCO3). “Do you know how often Mrs. Burroughs takes the Alka-Seltzer®?” the doctor asked Bobby. “Or how many Tums®?” “Oh, I’m not sure. I can’t be with her all day, and she lives alone. We take turns checking on her—me, my daughter, and my brother’s family. But I don’t understand why you need to know about these,” replied Bobby, looking closely at the bottle of brightly colored tablets. “We buy them at the grocery store—it’s not like they’re medicine, or anything.” Just then, Mr. Burroughs’ daughter, Charlotte, entered the examination room. Charlotte was a biology major in college. “I came as fast as I could,” she added,” but traffic from school was a bear. ‘s wrong with Granny?” “We were just looking at your grandmother’s medicines,” said the doctor. Your father was trying to give me some more information so we can figure out what’s causing her problems. Do you know anything about the Alka-Seltzer® or the Tums® he found on her kitchen table?” Charlotte looked at the physician and her dad. “Granny was taking the Alka-Seltzer® this week because she was complaining about an ulcer. She said this was how they used to treat them when she was a girl. She always took it when I was there. I think she was drinking a lot of milk lately, too, and she said it was good for her stomach. And she always took the Tums® because they are supposed to be good for your bones, right? I think she took those twice a day.” “Now that you mention it,” Bobby chimed in, “she took the Alka-Seltzer® every time I was there too. I think she’s finished about two gallons of milk just this week, which is surprising since she usually doesn’t like milk. I always thought it was sort of funny that she didn’t like the taste of milk even though she grew up on a dairy farm.” “Hmmmm, I think we’d better see what her parathyroid hormone levels are,” the physician said. “I’ll have those measurements made right away. I’ve got a hunch that we’ll find there is more wrong with her kidneys than we thought before.” An alarm went off on his pager. “Excuse me for just a minute—I need to check on another patient before she goes home. Don’t go away and don’t worry—your mother is in excellent hands.” 1. Should you and the family be concerned about anything that Mrs. Burroughs takes that is not a prescription medicine? Why or why not? 2. Could any of Mrs. Burroughs’ current problems be related to the drugs (over-the-counter or prescription) she has been taking? Describe why you think there is a relationship. 3. is parathyroid hormone (PTH)? Where does it come from and what is its function?  are normal levels for PTH? 4. Why do you think the physician wants to know about the levels of this hormone?

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