How does chronic alcoholism impact the cardiovascular system?

15 [28 POINTS + 8 POINTS BONUS]

 

  1. A 38yo caucasian male presents to the ER after a 2 week bender of heavy alcohol consumption. He admits to drinking 5 handles of whiskey in the past 2 days. He claims that he has started to vomit up blood and has lost 15 pounds in the last 2 weeks due to not having an appetite. He eats mainly Ho-Hos and Twinkies. He is experiencing epigastric abdominal pain and has significant melena. He also has ataxic gait, poor muscle coordination, and significant confusion. His skin and sclera have a yellow hue, he has moderate hepatomegaly, pitting edema in his legs, and significant abdominal ascites.
    1. The patient is significantly dehydrated. Explain the physiological reason for this based on his history of heavy alcohol consumption. Alcohol specifically causes profound diuresis because causes what condition of the endocrine system? Which hormone is affected? Explain your answer. [4 POINTS]

 

 

 

 

 

 

 

 

 

  1. Describe effects of chronic alcoholism on the GI system. What are THREE conditions that this patient needs to be evaluated for based on his history? Support your answers with supporting items from patient’s history. [6 POINTS]

 

 

 

 

 

 

 

 

 

  1. The patient’s lab values are shown below. Interpret his lab values and vitals. Which values are high, low, and normal. For each result that is not within normal range, explain why it is high or low in this patient. [12 POINTS]

 

Blood Gas Analysis (prior to intubation) Biochemistry
pH 7.07 Total bilirubin 6.7 mg/dl
PaCO2 51.3 mmHg AST 335 U/L
PaO2 73 mmHg ALT 162 U/L
HCO3- 14 mEq/L Lactate 3.1 mmol/L
    Creatine kinase 123 U/L
Blood glucose 230 mg/dl BUN 42.3 mg/dl
CBC   Cr 3.7 mg/dl
WBC 11890 /mm3 Na+ 164 mEq/L
RBC 7.21×104 /mm3 K+ 6.6 mEq/L
Hct 51.2 % Cl- 96 mEq/L
Hgb 17.4 g/dl Ca2+ 9.8 mg/dl
Plt 7.0×104 /mm3 Phosphorus 3.1 mg/dL

 

 

  • BP: 105/69 mmHg, HR: 118 bpm, Temperature: 38.9 °C
  • O2 saturation: 92% on room air, Respirations: 8 breaths/min and shallow

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Is there an acid-base disorder present? If so, what is the disturbance? Show your work and explain your answer clearly (HINT: use the step-wise method that I demonstrated during class for determining an acid-base disorder). Is there compensation? Explain? What is the likely cause of the acid-base disturbance, if present? Explain your answer. [6 POINTS]

 

 

 

 

 

 

 

 

  1. **EXTRA CREDIT** Describe the nutritional deficiencies that chronic alcoholism has caused in this patient. Why is he displaying ataxic gait, lack of coordination, and confusion? What vitamin or mineral deficiency would these symptoms likely result from? What is this condition called? What other nutritional deficiencies would this patient be at increased risk for? Why? [5 POINTS]

 

 

 

 

 

 

 

 

 

 

  1. **EXTRA CREDIT** How does chronic alcoholism impact the cardiovascular system? What type of cardiomyopathy is likely to be caused by chronic alcoholism? Explain your answer. [3 POINTS]