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art 1 - The Patient previously healthy 21-year-old male is admitted to the emergency room of the local hospital after his mother itnessed his sudden loss of consciousness after returning from a workout at the local fitness gym. He was broug y ambulance and is now conscious but disoriented with slurred speech. He also complains of "feeling off" and reeping on his skin." On arrival to triage, his vital signs are as follows: blood pressure 125/70 mm Hg (normal clow 120/80 mm Hg), pulse rate 80 beats/min (normal range: 60-100 beats/min), and respiratory rate 16 brea in (normal range: 12-16 breaths/min). The patient does not have fever, chills, or sweats. During the examinati he doctor learns that the patient has had intermittent lethargy, nausea, and vomiting over a one-week period. I atient had assumed that his lethargy was due to overexertion from working out since he had recently started a n xercise regimen to gain muscle mass. Over the first 24 hours of admission, the patient becomes increasingly dise nted and aggressive. By the 36th hour, the patient begins having seizures. You are shadowing your local ER phys ho challenges you to determine what might be causing these symptoms. he physician begins his diagnosis by conducting a medical interview, a physical examination, and ordering labor ests for a thorough analysis of the patient's condition. Medical Interview he ER physician interviews the patient, asking about any previous diseases or past hospitalizations, current condi nd overall physical and mental health. The medical history of the patient is found to be unremarkable for any chi onditions. The patient states that he has never had an episode of altered mental status nor was taking any medica he ER physician then interviews the patient's mother, who is in the ER with him. She reports that her son, in a ttempt to become more fit, recently started the Atkins diet, which consists of restricting carbohydrates while all nlimited amounts of protein and fat. He was also taking a high-protein supplement, and had recently joined a and was doing daily strenuous workouts. hysical Examination he ER physician conducts a physical examination on the patient, including a careful examination and palpation f the abdomen. The patient does not report any feelings of pain or tenderness in his abdomen. All palpated org ncluding the liver, appear to be normal in size. aboratory Results lood samples were taken from the patient upon ER admission. No common poisons were found in a toxicology When the reults of the patient's bloodwork come back from the laboratory, the ER physician allows you to look rintout (Table 1).

art 1 - The Patient previously healthy 21-year-old male is admitted to the emergency room of the local hospital after his mother itnessed his sudden loss of consciousness after returning from a workout at the local fitness gym. He was broug y ambulance and is now conscious but disoriented with slurred speech. He also complains of "feeling off" and reeping on his skin." On arrival to triage, his vital signs are as follows: blood pressure 125/70 mm Hg (normal clow 120/80 mm Hg), pulse rate 80 beats/min (normal range: 60-100 beats/min), and respiratory rate 16 brea in (normal range: 12-16 breaths/min). The patient does not have fever, chills, or sweats. During the examinati he doctor learns that the patient has had intermittent lethargy, nausea, and vomiting over a one-week period. I atient had assumed that his lethargy was due to overexertion from working out since he had recently started a n xercise regimen to gain muscle mass. Over the first 24 hours of admission, the patient becomes increasingly dise nted and aggressive. By the 36th hour, the patient begins having seizures. You are shadowing your local ER phys ho challenges you to determine what might be causing these symptoms. he physician begins his diagnosis by conducting a medical interview, a physical examination, and ordering labor ests for a thorough analysis of the patient's condition. Medical Interview he ER physician interviews the patient, asking about any previous diseases or past hospitalizations, current condi nd overall physical and mental health. The medical history of the patient is found to be unremarkable for any chi onditions. The patient states that he has never had an episode of altered mental status nor was taking any medica he ER physician then interviews the patient's mother, who is in the ER with him. She reports that her son, in a ttempt to become more fit, recently started the Atkins diet, which consists of restricting carbohydrates while all nlimited amounts of protein and fat. He was also taking a high-protein supplement, and had recently joined a and was doing daily strenuous workouts. hysical Examination he ER physician conducts a physical examination on the patient, including a careful examination and palpation f the abdomen. The patient does not report any feelings of pain or tenderness in his abdomen. All palpated org ncluding the liver, appear to be normal in size. aboratory Results lood samples were taken from the patient upon ER admission. No common poisons were found in a toxicology When the reults of the patient's bloodwork come back from the laboratory, the ER physician allows you to look rintout (Table 1).

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Atkins or Ammonia? Nitrogen Metabolism and the Urea Cycle by Stephanie Dingwall and Tammy Nguyen Department of Biochemistry University of California, Riverside Part I-The Patient A previously healthy 21-year-old male is admitted to the emergency room of the local hospital after his mother witnessed his sudden loss of consciousness after returning from a workout at the local fitness gym. He was brought in by ambulance and is now conscious but disoriented with slurred speech. He also complains of "feeling off" and "things creeping on his skin." On arrival to triage, his vital signs are as follows: blood pressure 125/70 mm Hg (normal range: below 120/80 mm Hg), pulse rate 80 beats/min (normal range: 60-100 beats/min), and respiratory rate 16 breaths/ min (normal range: 12-16 breaths/min). The patient does not have fever, chills, or sweats. During the examination, the doctor learns that the patient has had intermittent lethargy, nausea, and vomiting over a one-week period. The patient had assumed that his lethargy was due to overexertion from working out since he had recently started a new exercise regimen to gain muscle mass. Over the first 24 hours of admission, the patic t becomes increasingly disori- ented and aggressive. By the 36th hour, the patient begins having seizures. You are shadowing your local ER physician, who challenges you to determine what might be causing these symptoms. The physician begins his diagnosis by conducting a medical interview, a physical examination, and ordering laboratory tests for a thorough analysis of the patient's condition. Medical Interview The ER physician interviews the patient, asking about any previous diseases or past hospitalizations, current conditions, and overall physical and mental health. The medical history of the patient is found to be unremarkable for any chronic conditions. The patient states that he has never had an episode of altered mental status nor was taking any medication. The ER physician then interviews the patient's mother, who is in the ER with him. She reports that her son, in an attempt to become more fit, recently started the Atkins diet, which consists of restricting carbohydrates while allowing unlimited amounts of protein and fat. He was also taking a high-protein supplement, and had recently joined a gym and was doing daily strenuous workouts. Physical Examination The ER physician conducts a physical examination on the patient, including a careful examination and palpation of the abdomen. The patient does not report any feelings of pain or tenderness in his abdomen. All palpated organs, including the liver, appear to be normal in size. Laboratory Results Blood samples were taken from the patient upon ER admission. No common poisons were found in a toxicology test. When the reults of the patient's bloodwork come back from the laboratory, the ER physician allows you to look at the printout (Table 1).
Transcribed Image Text:Atkins or Ammonia? Nitrogen Metabolism and the Urea Cycle by Stephanie Dingwall and Tammy Nguyen Department of Biochemistry University of California, Riverside Part I-The Patient A previously healthy 21-year-old male is admitted to the emergency room of the local hospital after his mother witnessed his sudden loss of consciousness after returning from a workout at the local fitness gym. He was brought in by ambulance and is now conscious but disoriented with slurred speech. He also complains of "feeling off" and "things creeping on his skin." On arrival to triage, his vital signs are as follows: blood pressure 125/70 mm Hg (normal range: below 120/80 mm Hg), pulse rate 80 beats/min (normal range: 60-100 beats/min), and respiratory rate 16 breaths/ min (normal range: 12-16 breaths/min). The patient does not have fever, chills, or sweats. During the examination, the doctor learns that the patient has had intermittent lethargy, nausea, and vomiting over a one-week period. The patient had assumed that his lethargy was due to overexertion from working out since he had recently started a new exercise regimen to gain muscle mass. Over the first 24 hours of admission, the patic t becomes increasingly disori- ented and aggressive. By the 36th hour, the patient begins having seizures. You are shadowing your local ER physician, who challenges you to determine what might be causing these symptoms. The physician begins his diagnosis by conducting a medical interview, a physical examination, and ordering laboratory tests for a thorough analysis of the patient's condition. Medical Interview The ER physician interviews the patient, asking about any previous diseases or past hospitalizations, current conditions, and overall physical and mental health. The medical history of the patient is found to be unremarkable for any chronic conditions. The patient states that he has never had an episode of altered mental status nor was taking any medication. The ER physician then interviews the patient's mother, who is in the ER with him. She reports that her son, in an attempt to become more fit, recently started the Atkins diet, which consists of restricting carbohydrates while allowing unlimited amounts of protein and fat. He was also taking a high-protein supplement, and had recently joined a gym and was doing daily strenuous workouts. Physical Examination The ER physician conducts a physical examination on the patient, including a careful examination and palpation of the abdomen. The patient does not report any feelings of pain or tenderness in his abdomen. All palpated organs, including the liver, appear to be normal in size. Laboratory Results Blood samples were taken from the patient upon ER admission. No common poisons were found in a toxicology test. When the reults of the patient's bloodwork come back from the laboratory, the ER physician allows you to look at the printout (Table 1).
4. The physician then provides you a website to reference: Healthgrades Editorial Staff. (2022). Elevated blood ammonia level: what it means and what to do [webpage]. Healthgrades. <https://www.healthgrades.com/right-care/kidneys-and-the-urinary-system/ elevated-blood-ammonia-level> Based on the reference provided and the information you have about the patient so far, list all possible causes for his elevated blood ammonia level.
Transcribed Image Text:4. The physician then provides you a website to reference: Healthgrades Editorial Staff. (2022). Elevated blood ammonia level: what it means and what to do [webpage]. Healthgrades. <https://www.healthgrades.com/right-care/kidneys-and-the-urinary-system/ elevated-blood-ammonia-level> Based on the reference provided and the information you have about the patient so far, list all possible causes for his elevated blood ammonia level.
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