Fr. Saturnino Urios University

CHEMISTRY 2

CHAPTER 13: ENZYMES Case Study 13-1 A 51-year-old, overweight white man visits his family physician with a symptom of “indigestion” of 5 days’ duration. He has also had bouts of sweating, malaise, and headache. His blood pressure is 140/105 mm Hg; his family history includes a father with diabetes who died at age 62 of AMI secondary to diabetes mellitus. An electrocardiogram revealed changes from one performed 6 months earlier. The results of the patient’s blood work are as follows: CK 129 U/L (30–60) CK-MB 4% ( LD-2 AST 35 U/L (5–30) Questions 1. Can a diagnosis of AMI be ruled out in this patient? 2. What further cardiac markers should be run on this patient? 3. Should this patient be admitted to the hospital? Case Study 13-2 While a 71-year-old woman is walking home from a shopping center, she faints and falls. She is driven home by a friend. When home, she realizes that she is bleeding from her mouth and is slightly disoriented. She appears injured from the fall, but she does not remember tripping or falling. The woman is taken to a local emergency department. The examining physician determines that there was a loss of consciousness; to determine the reason, he orders a head CT and ECG and the following laboratory tests: CBC, PT, aPTT, CK, LD, AST, and troponin T and troponin I. All tests are within normal limits. The woman is sutured for the mouth injuries and admitted to a 24-hour observation unit. Questions 1. What possible diagnoses is the physician considering? 2. What laboratory tests would be elevated at 6, 12, and 24 hours if this patient had an AMI? 3. What isoenzyme tests would be useful with this patient? Case Study 13-3 A 36-year-old woman presents to the emergency department with intense upper abdominal pain radiating to her back, weakness, loss of appetite, and severe indigestion after eating. She had not traveled in recent months. She has not been well for several days. Questions 1. What laboratory tests should be ordered to help diagnose this patient? 2. What enzyme tests will be useful in diagnosing this patient? 3. What two diagnoses are most likely for this patient?