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SCHEMATIC PATHOPHYSIOLOGY

Predisposing Factors
1. Family history of DM and HTN
maternal side
2. Diet- high sodium, low water(3-4)
3. DM Type II- 1999 non- compliant
4. HTN- 2004
5. Chronic Renal Failure- 2007

Inability of glucose to get inside the cell

Decrease ATP

glycolysis

Fatty streaks adhere to blood vessel lining

atherosclerosis
Mass Effect Decreased Cardiac Output Myocardial Tissue Ischemia
T-wave inversion
(ECG February 10, 2009)

Increased work load Bounding carotid Decreased oxygenation to the kidneys Anaerobic metabolism
of the Left Ventricle pulse (+4)

Left Ventricular Activation of RAAS Lactic acid


Hypertrophy production
( 2D Echo Feb 10, 2009)

Sodium Tubular Myocardial Tissue


Damaged reabsorption Necrosis Injury
Bicuspid Valve
( 2D Echo Feb 10, 2009) Vasoconstriction

Water Retention Myocardial Tissue


Dilation of the Necrosis
Left Atrium SGPT - 348
( 2D Echo Feb 10, 2009) (+) TROPONIN I
Increased BP 160/100

Backflow of blood to the Lungs Crackles Increased WBC


(139 cc seen in CXR taken Tachypnea CBC
Damaged Kidney Feb. 10, & 11, 2009
February 10, 2009 ) Orthopnea
Function
Decreased Glomerular Proteinuria Creatinine Reabsorption Glucosuria Hematuria Secretory
Filtration Rate (+4 albumin U/A BUN (+1 sugar U/A 18 – 23/HPF
Feb. 10& 12, 2009) Taken Feb. 10& 12, Taken Feb. 10, 2009
2009) 21 – 26/HPF
Feb. 12, 2009
Decreased urine Lethargy Decreased
output Tea-colored
reabsorption of Decreased
urine
bicarbonates Decreased RBC, erythropoeitin
Hypoalbuminemia
Hct, Hgb
2.46
(February 10, 2009)
CBC
Feb. 10, 11, 12, 2009
Metabolic acidosis
(ABG February 10,
Decreased
2009)
calcitriol
Increased capillary Pallor
Fluid Dry scaly skin Delayed capillary
permeability
shifting Cracked lips refill time
Cool extremities Hypocalcemia
Tachypnea 7.3
Tachycardia (February 10, 2009)
Diminished Pitting bipedal Ascites Jugular vein
pulses edema (+3) distension