chbare Posted June 10, 2009 Author Share Posted June 10, 2009 Ok can I have some blood work sent out CMP CVC LFP and a urine tox screen This is very strange? I thought I had commented on your post earlier today, yet my comment is not visible on this thread? Could you explain the meaning of CVC and LFP? I know of a CBC and LP. In addition, what conditions are you looking to rule out/in with these labs? Take care, chbare. Link to comment Share on other sites More sharing options...
joesph Posted June 11, 2009 Share Posted June 11, 2009 (edited) This is very strange? I thought I had commented on your post earlier today, yet my comment is not visible on this thread? Could you explain the meaning of CVC and LFP? I know of a CBC and LP. In addition, what conditions are you looking to rule out/in with these labs? Take care, chbare. Yeah it disappeared weird anyway looking into several things wanting to look at liver enzymes, white cell count ect. Spoke to a nurse that runs with use he recommended this blood work rather then being to narrow sighted in what I'm looking he recommended these because they would look at a full metabolic panel. I will get the abbreviations expanded next time i talk to him. The urine tox screen is to look into contamination from anything from home brew to heavy metals( i think I get that one to from this test) I am leaning towards a liver problem but have not left the hernia alone problem is if its a hernia and no imaging equipment I am not sure where to go with it. If it is a hernia and we hit the jackpot on the white cell count its time to boogie. Oh yeah I may have pooched the LFP for LP or it could be local differences I'll check. Edited June 11, 2009 by joesph Link to comment Share on other sites More sharing options...
chbare Posted June 11, 2009 Author Share Posted June 11, 2009 Ok, with the liver issues, I can see a CMP and even a CBC. However, what are you looking at performing a lumbar puncture (LP)? In addition, the typical urine tox screen will not detect heavy metal contamination. I will give it to you on the basis of looking for hepatotoxic substances. You are able to obtain the following labs within 12 hours: CBC Hemoglobin: 13.5 g/dl Hematocrit: 42% WBC: 9.5 K/mm3 PLT: 190 k/ml Chemistry NA+: 137 mEq/L K+: 3.7 mEq/L CL-: 102 mEq/L BUN: 9.7 mg/dl Creatinine: 0.9 mg/dl BGL: 105 ~ 5.8 mmol/L AST: 50 U/L ALT: 52 U/L UDS APAP (-) ASA (-) THC (-) Cocaine (-) Amphetamines (-) Opiates (-) LSD (-) Blood ETOH: 0 mg/dl Take care, chbare. Link to comment Share on other sites More sharing options...
Jeepluv77 Posted June 11, 2009 Share Posted June 11, 2009 Just a thought here. Have we ruled out malaria and lyme disease? Link to comment Share on other sites More sharing options...
chbare Posted June 11, 2009 Author Share Posted June 11, 2009 Just a thought here. Have we ruled out malaria and lyme disease? Not unreasonable to consider these diseases at all. These are not the cause of his signs and symptoms; however, good call on conditions to rule out. Take care, chbare. Link to comment Share on other sites More sharing options...
FireMedic65 Posted June 11, 2009 Share Posted June 11, 2009 This has gone a bit over my head. Still a great case to follow though. Link to comment Share on other sites More sharing options...
chbare Posted June 11, 2009 Author Share Posted June 11, 2009 This has gone a bit over my head. Still a great case to follow though. You may think. However, with all the labs and distracting stuff, focus on the history and physical exam. This will most likely be the most important part to solving the riddle. This is one condition that you must suspect and have on your list of differentials, or you may not even think about ordering the proper diagnostics to definitively make the diagnosis. Take care, chbare. Link to comment Share on other sites More sharing options...
Katiebug Posted June 11, 2009 Share Posted June 11, 2009 Guess #1) Hemochromatosis. A build up of iron causing the S/S the pt has. Is he jaundiced? Link to comment Share on other sites More sharing options...
Jeepluv77 Posted June 11, 2009 Share Posted June 11, 2009 I hadn't looked into the brother too much. Do we have an age on this guy? Is his brother a twin and if not can we get his age? Any family history of liver, gallbladder, pancreatic, etc problems? Any family history of sickle cell disease or the like? How about possible exposure to hepatitis or family history of autoimmune hepatitis? Family history of rheumatoid arthritis? I know these are long shots, but figure why not rule them out, too? Link to comment Share on other sites More sharing options...
ERDoc Posted June 12, 2009 Share Posted June 12, 2009 I haven't read through all of the posts so forgive me if I repeat anything. Tell us a little more about this palpable mass in the RUQ. Is there any hepatomegaly? Do we have access to a portable US? If so what do we see in the RUQ? Any diarrhea or wt loss? Let's send stool for ova and parasites. Is his brother here also? Link to comment Share on other sites More sharing options...
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