SCHEMATIC PATHOPHYSIOLOGY

Predisposing Factors
1. Family history of DM and HTN
maternal side
2. Diet- high sodium, low water
(3-4 glasses) ↑ RBS
3. DM Type II- 1999 non- compliant 11.99 mmol/L
4. HTN- 2004 2/10/09
5. Chronic Renal Failure- 2007

Inability of glucose to get inside the cell

Decrease ATP

glycolysis

Fatty streaks adhere to blood vessel lining

↓ Blood supply in the ↓ Blood Supply Poor Vision

Dry, scaly skin Atherosclerosis both eyes
periphery in the retina
 Mass Effect ↓ Cardiac Output Myocardial T-wave
Tissue inversion
Ischemia ECG 2/10/09

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

Left Ventricular Activation of RAAS Lactic

Hypertrophy acid
( 2D Echo Feb 10, 2009)

Sodium Tubular
Myocardial ST
Damaged reabsorption Necrosis abnormality
Tissue
Bicuspid Valve ECG 2/10/09
Vasoconstriction Injury
( 2D Echo Feb 10, 2009)

Water Retention Myocardial Tissue

Dilation of the Necrosis
Left Atrium
( 2D Echo Feb 10, 2009)

Increased BP 160/100 ↑WBC + Trop I

11.7- 2/10/09
11.0- 2/11/09
Backflow of blood to the Lungs Crackles ↑ SGPT
(139 cc seen in CXR taken Tachypnea Damaged Kidney 348 u/L
February 10, 2009 ) Orthopnea Function
 Decreased Impaired ↓ GFR Impaired Impaired Decreased
erythropoietin excretion of Filtration Reabsorption Calcitriol
production waste products of Bicarbonates Production

Decreased
↓ Urine Proteinuria Glucosuria Hematuria erythropoietin
output +4- 2/10/09 +1- 2/10/09 18-23/HPF
↓RBC 2.52- 2/10/09 ↑Creatinine 2/10/09 production
2.91- 2/11/09 +4- 2/12/09 +1- 2/12/09 Metabolic Impaired
2129.30 mmol/L 21-26/HPF
3.34 - 2/12/09 2/12/09 acidosis Absorption
2/10/09
↓Hgb 80- 2/10/09 Water ABG 2/10/09 of dietary
2357.60 mmol/L
90- 2/11/09 2/11/09 Retention Hypoalbuminemia Hazy urine Calcium
108- 2/12/09 2/10/09 Tea-colored
2.46 g/dl
↓Hct 0.22-2/10/09 ↑ BUN Cloudy urine urine
0.25- 2/11/09 149.75 mmol/L 2/12/09
0.31- 2/12/09 Distended Hypocalcemia
2/10/09 ↓ Oncotic
165.81 mmol/L Jugular 7.3 mg/dl
Pressure
2/11/09 Veins
Delayed
Capillary ↓ Sodium
Refill Time Fluid
109.3 mmol/L
4 seconds Shifting
Lethargy 2/10/09

Pallor +3 Ascites
pitting
Hard to palpate Bipedal
Distal pulses edema