Biochemistry C.

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 Clinical case no. 1
A 55-year-old patient presents at the ED complaining of marked asthenia, vomiting, dark
urine (reddish-brown) and icterus (yellow) skin. From the patient's history it si noted: flu that
started 2weeks ago treated with paracetamol for 2weeks, dose of 5gr/24 hours (maximum
dose being 3gr/24 hours). Laboratory analyzes show increased values for GPT (5500 U/L),
GOT (5240 U/L), GGT (1025 U/L). Total Bilirubin (12 mg/dL) and Direct Bilirubin (5.8 mg/dL).
ALP is within normal limits.

Clinical case no. 2

A 65-year-old patient presents to the ED with an altered general condition, generalized
abdominal pain, fever, chills, vomiting, jaundiced skin and sclera. Laboratory analyzes show
increased values for: total bilirubin = 12 mg/dI; direct bilirubin = 9 mg/dl; GGT = 765 U/L; ALP
= 830 U/L; GPT = 23 U/L and GOT = 21 U/L.
Clinical case no. 3
A 76-year-old patient presents ot the ED with pain in the right hypochondrium, nausea, vomiting
and jaundiced skin. Laboratory analyzes show increased values for: total bilirubin = 8.4 mg/dI;
direct bilirubin = 7.3 mg/di; GGT = 560 U/L; ALP = 610 U/L; GPT = 180 U/L and GOT = 210 UL.

Clinical case no. 4

A 35-year-old homeless patient is found lying in the street. He is brought by ambulance to ED
in a coma. A thorough check reveals skull fractures and an alcoholic breath. Laboratory
analyzes indicate: GGT = 1020 U/L; ALP = 50 U/L; LDH = 1670 U/L; GPT = 3480 UL/ and
GOT = 2810 U/L; total bilirubin = 4 mg/di; direct bilirubin = 2.1 mg/dl.
Clinical case no. 1
A 61-year-old patient presents in the ED with claw-like chest pain radiating to the epigastrium,
vomiting, skin pallor. ECG shows ST segment elevation. Laboratory analyzes reveal: CK
= 4 0 0 U / L ; C K - M B = 3 7 U / L ; G O T = 3 4 0 U / L ; G P T = 2 5 U / L ; L D H = 5 2 0 U L/ .

Clinical case no. 2

A 32-year-old patient, a performance athlete who practices athletics, is
brought to the hospital by ambulance after finishing a marathon. 5 months ago he had
fractured his 5th metatarsal and was out of training for 4 months before the marathon.
During the objective examination, very great pains in the muscles of the lower limbs and
the impossibility of movement are found. Laboratory analyzes reveal: CK = 2320 U/L,
CK-MB = 10 U/L; GOT = 7540 U/L; GPT = 12 U/L.
Clinical case no. 3
A 67-year-old patient presented ot the emergency urology service for urinary retention. A
catheter is inserted through a suprapubic bladder catheter. Laboratory analyzes reveal:
AP= 57 U/L; Prostatic AP = 23.5 U/L; PSA = 25 ng/ml.

Clinical case no. 1

A 55-year-old, obese patient presents in the ED for abdominal pain radiating in the form of a
bar, nausea, vomiting and general altered state. History reveals that hte patient attended a
wedding 2 days ago where he consumed fatty foods and alcohol excessively, although he
does not drink alcohol frequently. He was admited ot the General Surgery Department
folowing a surgical procedure. Before the surgical procedure, laboratory analyzes revealed:
Serum amylase = 1080 U/L; Urinary amylase = 800 U/L; Serum elastase = 585 U/L; Serum
lipase = 950 UL/.
 Clinical case no. 2
The patient from case 1 presents one year after the previous admission with similar symptoms.
This time he declares that he did not drink any more alcohol, but only that he ate a portion of
fries at home. This time he was admitted to the Department of Internal Medicine. Laboratory
analyzes revealed: Serum amylase =60 U/L; Urinary amylase =200 U/L; Serum lipase = 80 U/L;
Serum elastase = 450 U/L.

Clinical case no. 3

A 58-year-old patient with multiple chronic diseases (hypotension, DM) presents in the ED
because of the inability to feed, sore throat, fever and chills. In the past, the patient received
radiotherapy to the neck and mentions that the radiotherapy had a curative role. He also
mentions that he has had a dry mouth for 2 weeks. The physical examination reveals inflamed-
purulent tonsils. Bacteriological examinations revealed the growth of Staphylococcus aureus
from the purulent product collected from the pharynx. Inflammatory markers had increased
values (CRP, ESR, fibrinogen). Serum amylase had an increased value of 440 UL, and the other
enzymes (lipase, elastase) had normal values.
Clinical case no.1
A 64-year-old patient presented in the ED with an altered general condition, dizziness, nausea,
vomiting, extensive precordial pain radiating to the epigastrium. Laboratory analyzes= reveal a
decrease in no. catalase = 8 , CK = 5 8 0 U / L ; CK-MB = 49 U/L; GOT = 810U/L; GPT 20 U/L;
LDH = 1220 U/L.

Lp. 5
Clinical case no. 1
A 2-year-old child presents himself with his parents for a routine check-up at the family doctor.
He notes a sunken sternum, anterior fontanel not completely closed, and dental
demineralization. The parents stated that they administered vitamin D to the child daily. The
family doctor requests tests for total Calcium, Vitamin D3 and ALP. When dosing them, low
values below NV are observed.
 Clinical case no. 2
A 25-year-old patient is brought by ambulance in the ED for: confusion, hallucinations,
convulsions, muscle weakness, signs of tetany, rhythm disorders. Laboratory analyzes show
normal values for Ca and low values for Mg.

Clinical case no. 3

A 17-year-old patient presented in the ED in crisis, manifested by: numbness of
the tongue, blurred vision, headache, paresthesias (upper limbs), marked fatigue. Claims
consumption of fast food, low-dairy diet. Laboratory analyzes indicate: Ca (total and ionic)
and Mg with very low values.
Clinical case no. 1
A 50-year-old patient presents to the emergency room after intense physical exertion with: atrial
fibrillation, confusion, dyspnea, acidosis, K=5mmol/L, Na = 129 mmol/L decreased .

Clinical case no. 2

The 60-year-old patient presents to the emergency room with: atrial fibrillation, confusion,
dyspnea. He has a chronic kidney disease. Laboratory analyzes show elevated values for urea,
creatinine, uric acid and K.
Clinical case no. 3
A 54-year-old patient presents to the UPU with: weakness, fatigue, dyspnea, rhabdomyolysis
(he was treated with Crestor), cardiac arrhythmia, decreased osteo-tendinous reflexes in the
lower limbs, constipation. Cholesterol = wave increased in the antecedents. Laboratory
analyzes indicate: K= 2.3mEq/1, Cl = raised waves, Na =140mEq/1, Alkalosis. ECG = rhythm
changes.

Clinical case no. 1

A 65-year-old patient, diagnosed with rheumatoid arthritis, presents with painful inflammatory
pustules. Laboratory analyzes reveal increased values for CRP, fibrinogen, FR, ferritin.
Hemoglobin=10g/dl,HCT=29%,MCV=65fl(low)andMCH=21pg(low).Fe=25 ug/di (low) low TIBC
(total iron binding capacity).
Clinical case no. 2
A 30-year-old multiparous patient with metrorrhagia presents with fatigue, dizziness, frequent
lightheadedness, headache, pallor, cold extremities, marked asthenia. Laboratory analyzes
reveal low values for HGB (9 g/dl), MCV, MCH, MCHC, Fe, ferritin, Catoth, Ca+2, Mg+2, vitamin
D, and folic acid and vitamin B12 at the lower limit of normal.

Clinical case no. 3

A 24-year-old patient presents with cold sweats, frequent lipothymic states, confusional states,
menometrorrhagia (menstruation lasting 7 days, with the first 3 days of heavy flow; menstrual
cycle 12 days), obnubilation, marked asthenia. Laboratory analyzes show low values for HGB =
5 mg/dL, MCV, MCH, Sideremia, Ferritin, and normal values for cardiac triple (CK, CK-MB and
Troponin). 2 weeks ago he presented again with HGB = 9 mg/dL. She was prescribed Fe
treatment, being diagnosed with iron deficiency anemia.
Clinical case no. 4
50-year-old patient, diagnosed with duodenal ulcer ni the past, complains of pain ni the
epigastrium, palor, lipothymic states, asthenia, headache, palpitations, cold skin, nausea,
vomiting "in cofee grounds", melancholic stool. Laboratory tests show low values for HGB,
hematocrit, sideremia and normal values for MCV and MCH.

Clinical case no. 5

A 35-year-old patient presents with excessive fatigue, hairiness, behavioral disorders
(confusional states, irritability). Laboratory tests show low values for HGB = 9 mg/dL,
sideremia, and ferritin.
Clinical case no.6
Patient known in the antecedents as having microcytic hypochromic anemia due to iron
deficiency older than 1year and untreated, presents to the UPU with digestive pathology
such as: atrophy of the lingual, pharyngeal and esophageal mucosa with burns and
embarrassment when swallowing and abdominal pain. Laboratory tests show low values for
iron, ferritin, TIBC, HGB and MCV.

Clinical case 1
The mother presents with a 1-year-old male child with white, sparse, fragile, wiry, curly hair,
who complains of convulsive seizures and si intellectually and physicaly delayed, and si smaller
for his age. Not working. Soft bones. Buccal facies, but muscle hypotonia and delayed
ostetendinous reflexes can be detected on touch. Karyotyping is carried out, as aresult of
which the change on the xchromosome si found. nI the antecedents, Fe treatment was
administered with good doses without response.
Laboratory tests:
• Fe (low)
• MCV - (low)
• MCH - low
• Cu - low
• ceruloplasmin - low
Clinical case 2
Woman with a 3-4 year old girl, minimal or asymptomatic signs, only hypochromic microcytic
anemia refractory to Fe treatment.
Laboratory tests:
• With - Low (easy)
• Fe - low
• ceruloplasmin - low

Clinical case 3
An adult patient presents to the doctor complaining of seizures, mild dysphagia, nausea,
marked asthenia, mild pain in the right hypochondrium. Greenish-yellow ring on the
periphery of the cornea, slight coordination disorder.
Heredocollateral antecedents: brother diagnosed with Wilson disease. Laboratory tests:
• does not show anemia
• GPT - Inc
• GOT - Inc
• ALP and GGT - can be Inc or Normal
• Urinary Cu - Inc (especially after administration of Cu chelators)
Clinical case no. 1
A 53-year-old patient presents to the doctor for: diffuse pain (muscular, bone), extreme fatigue,
loss ofappetite, weight gain, constipation, hair loss, rough hair, dry skin, brittle nails. The patient
is diagnosed with depression in the antecedents, but follows her treatment. Laboratory analyzes
indicate: T3, T4 (dec), TSH (Inc), Iodine (dec), Fe (dec) (hypochromic microcytic anemia), VitD
deficiency, LDL (Inc)

Clinical case no. 2

A 73-year-old patient presents to the emergency room for: muscle weakness in the arms, angina
pectoris, feeling o f exhaustion, HTN, ECG: atrial fibrillation. Laboratory analyzes indicate: Iodine
(Inc), T3, T4 (Inc), TSH !, K+ (Inc).
Clinical case no.3
A 27-year-old patient presents to the doctor for insomnia, excessive sweating, weight loss in the
last six months without a specific reason, diarrhea, constant hunger, absent periods in the last
two months. laboratory analyzes indicate T3 and T4 are increased. TSH is decreased, iodine is
increased, and ECG shows sinus tachycardia.

Clinical case no. 4

A 46-year-old female patient presents to the family doctor for: shiny eyes, exophthalmos,
dy~phoria, irritability, constant feeling of hunger, diarrhea, tremors, sinus rhythm 100 bpm,
moist skin palpitations they sub near decreasing weight in the last month. Laboratory
analyzes indicate T3,T4 aew increased, FT3 and FT4 are increased. APO is equal to 3000
units per milliliter ,TSH 0.002 uU/L and iodine is increased.
Clinical case no. 5
A 57-year-old patient with a history ofHashimoto's thyroiditis presents with the following
complaints: agitation, irritability, insomnia, verrucous, slightly smooth and moist skin, marked
fatigue. Laboratory analyses: T3, T4 - upper limit, TSH - towards the lower limit 0.6 μU/L.

Clinical case no. 6

A 33-year-old patient complains that she has recently gained 2-3 kg of weight, she wants to
lose weight but she can't. She is unable to get pregnant. Laboratory analyses: T3 and T4
decreased, TSH = 10 μU/L.
Clinical case no. 1
A 58-year-old male patient presented ot the ED with the folowing symptoms:
• Fever (39.6°C)
• Tachycardia (120 BPM)
• Tachypnea (25 resp/min).
X-ray reveals: condensed pulmonary areas with heterodense appearance

Laboratory analyzes reveal:

ESR = 10 mm/Hg
CP=340mg/dL (inc)
Presepsin = 100 ng/ml (Inc)
PCT=3.5ng/dL (inc)
Ferritin =200 ng/mL N
Fibrinogen = 580 mg/dL (Inc)
LDH=2250U/L (Inc)
TGP = 230 U/L (Inc)
TGO = 340 U/L (Inc)
Creatinine = 3.4 mg/dL (Inc)
Urea = 247 mg/dL (Inc)
Clinical case no. 2
A 65-year-old patient presents ot the hospital with pain in the ribs, spine, upper
and lower limbs.
Temperature =37°C, heart rate =83 BPM, respiratory rate =18 breaths/minute.

Laboratory analyzes reveal:

- CRP = 125 mg/dL (Inc)

- ESR = 5 mm/Hg (Inc)
- PCT = 0.07 ng/dL
- FIB = 880 mg/dL (Inc)

Clinical case no. 3

A 5-year-old child si brought ot the hospital by his parents ni November, for:
-Fever (39.8°C)
-Watery rhinorrhea
-Persistent crying
Clinical examination reveals inflamed pharynx and tonsils Laboratory analyzes reveal:
- CRP=35mg/dL (Inc)
- ESR = 10 mm/Hg
- PCT=1.2ng/dL (Inc)
- FIB =580 mg/dL (Inc)
Clinical case no. 4
A 76-year-old patient presented ot the ED, 5days after the onset of the first
symptoms, which initialy included difuse abdominal pain (slightly more intense in
the right hypochondrium), bloating and vomiting. At the presentation, clinically tit
was found:
• Fever (39.8°C), Tachycardia (120 BPM), Tachypnea (25 resp/min), Diffuse
abdominal pain, Skin pallor
After being admited ot the surgery ward, it is found that the patient urgently
needs surgical intervention in the abdominal area.
Laboratory analyzes before surgery (preoperative):
- Leukocytes (3,000 / mm3) dec ; Neu = 88% Inc 2 arrows
- ESR = 100 mm/Hg (Inc 3 arrows)
- CRP = 1240 mg/dL (inc)
- PCT = 7.5 ng/dL†
-Fibrinogen =480 mg/dL (inc)
- TGP = 30 U/L
- TGO=40UL/
- Creatinine = 1.7 mg/dL (Inc)
- Urea = 15 mg/dL (Inc)
48 hours after the operation, the patient's condition worsens suddenly, the patient developing
unresuscitable cardiorespiratory arrest.
Postoperative laboratory analyzes at 24 hours:
- Leukocytes (2,000 / mm3) dec; Neu = 95% Inc 3
• ESR= 120mm/Hg Inc 3
- CRP = 1100 mg/dL inc 3
- PCT =3 ng/dL inc 2
- Fibrinogen = 700 mg/dL inc 2
- TGP=230 U/L Inc 2
- TGO=250U/L Inc 2
- Creatinine= 8 .4mg/dL inc 3
- Urea = 175 mg/dL Inc 2
Clinical case no. 5
A 68-year-old patient presents to the ED for severe abdominal pain, melena, asthenia, weight
loss in recent months (approximately 10 kg).
Laboratory analyzes indicate:
-
ESR= 140mm/Hg Inc 3
-
CRP= 1300 mg/dL inc 3
-
PCT=0.05 ng/dL inc 2
-
Fibrinogen =600 mg/dL inc 2
-
Tumor markers CA 72-4, CA 19-9 and CAE increased