WEEK 3: ORGANS AND TOXICITY – CASE STUDIES
Aims:
● To consolidate clinical biochemistry topics from your
lecture programme.
● To encourage you to research information and become
independent learners.
● To apply principles of clinical biochemistry to clinical problem solving.
Question 1
A 25-year-old male complains of malaise and loss of appetite. He has felt feverish but has
not taken his temperature. He vomited once in the last week, but without blood. For two
weeks he has had aching joints without any obvious swelling of the joints. He has not
noticed any change in his urine or bowels. Five years ago, he had glandular fever which was
confirmed serologically. He is a heavy smoker and drinks on average 31 units of alcohol per
week. He uses recreational drugs occasionally, including cannabis and tablets, without
knowing the ingredients, but denies any intravenous drug use. He has had irregular
homosexual contacts but says that he has always used protection. An HIV test which was
negative 6 months earlier. He has not travelled outside Western Europe in the last 2 years.
There is no relevant family history.
His temperature is 38.6°C and he looks unwell and as if he may be a little jaundiced. He is a
little tender in the right upper quadrant of the abdomen. There are no abnormalities to find
on examination of the joints or in any other system.
Reference range
Haemoglobin 141 g/L 133 - 177 g/L
Mean corpuscular volume 85 fl 80- 99 fl
(MCV)
White cell count 11.5 x 10^9 /L 3.9 - 10.6 x10^9/L
Platelets 286 x 10^9 /L 150 – 440 x 10^9 / L
Prothrombin time 17 s 10 – 14 s
Sodium 135 mmol/L 135-145 mmol/L
Potassium 3.5 mmol/L 3.5 - 5.0 mmol/L
Urea 3.2 mmol/L 2.5 - 6.7 mmol/L
Creatinine 64 umol/L 70-120 umol/L
Bilirubin 50 umol/L 3-17 umol/L
Alkaline phosphatase 376 IU/L 30-300 IU/L
Alanine aminotransferase 570 IU/L 5-35 IU/L
Fasting glucose 4.1 mmol/L 4.0 - 6.0 mmol/L
• What is your interpretation of the findings?
Yellow – low
Green – normal
Red – high
Aims:
● To consolidate clinical biochemistry topics from your
lecture programme.
● To encourage you to research information and become
independent learners.
● To apply principles of clinical biochemistry to clinical problem solving.
Question 1
A 25-year-old male complains of malaise and loss of appetite. He has felt feverish but has
not taken his temperature. He vomited once in the last week, but without blood. For two
weeks he has had aching joints without any obvious swelling of the joints. He has not
noticed any change in his urine or bowels. Five years ago, he had glandular fever which was
confirmed serologically. He is a heavy smoker and drinks on average 31 units of alcohol per
week. He uses recreational drugs occasionally, including cannabis and tablets, without
knowing the ingredients, but denies any intravenous drug use. He has had irregular
homosexual contacts but says that he has always used protection. An HIV test which was
negative 6 months earlier. He has not travelled outside Western Europe in the last 2 years.
There is no relevant family history.
His temperature is 38.6°C and he looks unwell and as if he may be a little jaundiced. He is a
little tender in the right upper quadrant of the abdomen. There are no abnormalities to find
on examination of the joints or in any other system.
Reference range
Haemoglobin 141 g/L 133 - 177 g/L
Mean corpuscular volume 85 fl 80- 99 fl
(MCV)
White cell count 11.5 x 10^9 /L 3.9 - 10.6 x10^9/L
Platelets 286 x 10^9 /L 150 – 440 x 10^9 / L
Prothrombin time 17 s 10 – 14 s
Sodium 135 mmol/L 135-145 mmol/L
Potassium 3.5 mmol/L 3.5 - 5.0 mmol/L
Urea 3.2 mmol/L 2.5 - 6.7 mmol/L
Creatinine 64 umol/L 70-120 umol/L
Bilirubin 50 umol/L 3-17 umol/L
Alkaline phosphatase 376 IU/L 30-300 IU/L
Alanine aminotransferase 570 IU/L 5-35 IU/L
Fasting glucose 4.1 mmol/L 4.0 - 6.0 mmol/L
• What is your interpretation of the findings?
Yellow – low
Green – normal
Red – high
