January/2008

 

ANSWER 2 =C

 
DISCUSSION: The patient’s BUN to creatinine ratio is 11.8 ( < 20). Therefore, intrinsic renal disease is likely. Other data on the serum presented include a low bicarbonate which is known to be associated with metabolic acidosis, high ESR, and hypoalbuminemia. The latter two pieces of clinical data also suggest the presence of a chronic disease. Notice that a low serum bicarbonate may also indicate respiratory alkalosis or a combined, mixed acid-base disturbance. The latter type of process is seen clinically in more than half of hospitalized patient who are very ill