Cynthia, a 53-year-old female presented to the emergency room due to feeling constantly tired, hungry, thirsty, and with frequent urination. Her past medical history is significant for cirrhosis and end-stage kidney disease

Case: End-Stage Kidney Disease

Cynthia, a 53-year-old female presented to the emergency room due to feeling constantly tired, hungry, thirsty, and with frequent urination. Her past medical history is significant for cirrhosis and end-stage kidney disease. Physical examination had revealed yellowish discoloration to the skin, multiple bruises, bilateral edema, and weakness lasting more than three weeks. Laboratory tests were ordered (results provided below) after which she was prescribed metformin and informed to contact a doctor if she starts experiencing nausea, vomiting, fast breathing, and/or lethargy, as metformin has been known to cause metabolic acidosis.

Laboratory test results

Complete Blood Count (CBC)
Sodium	126 mEq/L
Glucose	220 mg/dl
Calcium	7.1 mg/dl
Red blood cell count	3.9 million cells/ul
Iron	40 mcg/dL
Albumin	2.5 g/dl
Vitals
Blood pressure	86/56 mmHg
Hormone Panel
Renin	Low
ADH	Elevated
Aldosterone	Low
Vitamins
Vit D	Low
Vit K	Low
Vit E	Low
Vit A	Low
Urine and Stool Sample
Stool color	Gray
Stool content	Increase fat content
Urine color	Clear
Glucose	Present

Answer the following questions regarding Cynthia’s case:

What hormone is not functioning properly causing Cynthia’s glucose levels to be abnormal? Furthermore, explain in depth how this hormone regulates blood glucose levels.

What other hormone(s) are responsible for maintaining normal glucose levels? Explain in depth how they work.

Explain why Cynthia is presenting with excessive thirst (polydipsia), tiredness and hunger (polyphagia), and frequent urination (polyuria).

Explain why Cynthia is experiencing hypotension. How does the body and its various organ systems bring the blood pressure back towards homeostasis?

What do you expect Cynthia’s heart rate and end-diastolic volume (EDV) to be (elevated, normal, or low) and justify your expectation with cardiovascular formulas such as cardiac output (CO) and stroke volume (SV).

What is the importance of iron in the body and explain why it is being 40 mcg/dL?

Explain in detail what gluconeogenesis is and where in the body it occurs? Knowing that gluconeogenesis helps maintain blood glucose level, what is the effect of metformin on the management of diabetes mellitus type 2?

Looking at Cynthia’s albumin levels, what effect does it have on her (a) blood osmolarity (b) glomerular filtration rate (GFR) and (c) urine volume?

Explain how glucose is normally reabsorbed by the kidneys? What is happening in Cynthia’s kidneys resulting in glucosuria and what effect does glucosuria have on blood pressure?

If Cynthia ends up developing metabolic acidosis, what would the levels of her pH, CO₂, and HCO₃ be in the blood? Furthermore, how would the body compensate and address both renal and respiratory compensation (optional: show the compensation via a flow chart)?

PHYS 261 Signature Assignment Rubric

Criteria	Exceeds Expectations	Meets Expectations	Approaches Expectations	Does Not Meet Expectations	Pts
Content/Information Prompt #1	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #2	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #3	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #4	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #5	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #6	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #7	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #8	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #9	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Content/Information Prompt #10	6.5 to >5.75 pts Exceeds Expectations Addresses the entire prompt correctly with great depth and details. Information is scientifically sound, thorough, necessary, and sufficient.	5.75 to >5.25 pts Meets Expectations Addresses the entire prompt correctly without depth or any details. Information is mostly scientifically sound, thorough, necessary, and sufficient.	5.25 to >4.5 pts Approaches Expectations Partially addresses the prompt correctly. Information is mostly insufficient and may not be scientifically sound.	4.5 to >0 pts Does Not Meet Expectations Does not address any portion of the prompt correctly. Information is not scientifically sound, necessary, or sufficient.	6.5 pts
Organization and Assignment Requirements	6.5 to >5.75 pts Demonstrates a sophisticated understanding of the topic(s) and issue(s). Introduction, abstract, and conclusion generally serve to bring cohesion and clarity to the assignment topic. Presents coherent and logically organized ideas that are thoughtful and in-depth. Meets all length requirements and addresses all aspects of the assignment. Meets the required number of resources, and all sources meet the assignment specifications.	5.75 to >5.25 pts Demonstrates an adequate understanding of the topic(s) and issue(s). Introduction, abstract, and conclusion generally serve to bring cohesion and clarity to the assignment topic, but there may be some redundancy or unnecessary information. Ideas are mostly coherent and organized. Meets all length requirements and addresses all aspects of the assignment. Meets the required number of resources, and all sources meet the assignment specifications.	5.25 to >4.5 pts Demonstrates a vague or incorrect understanding of the topic(s) and issue(s). Introduction, abstract, and conclusion do not add cohesion and clarity to the assignment topic. Several ideas are incoherent and disorganized. Meets some length requirements and addresses some aspects of the assignment. Meets the required number of resources, and some meet the assignment specifications.	4.5 to >0 pts Demonstrates little or no understanding of the topic(s) and issue(s). Introduction, abstract, and conclusion are missing or insufficient. Meets few, if any, assignment and reference criteria.	6.5 pts
APA and Mechanics	8.5 to >7.75 pts The assignment consistently follows current APA format and is free from citation and reference errors. There are no grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly.	7.75 to >6.75 pts The assignment consistently follows current APA format with only isolated and inconsistent mistakes and/or has a few grammatical, spelling, or punctuation errors. Most sources are cited and referenced correctly.	6.75 to >6.0 pts The assignment does not follow current APA format and/or has many grammatical, spelling, or punctuation errors. Many sources are cited and referenced incorrectly, or citations and references are missing where needed.	6 to >0 pts No attempt to follow APA format is indicated. Sources are not used and/or there is no reference page. Mechanical errors significantly interfere with the readability of the paper.	8.5 pts

Total Poi

Cynthia, a 53-year-old female presented to the emergency room due to feeling constantly tired, hungry, thirsty, and with frequent urination. Her past medical history is significant for cirrhosis and end-stage kidney disease

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Cynthia, a 53-year-old female presented to the emergency room due to feeling constantly tired, hungry, thirsty, and with frequent urination. Her past medical history is significant for cirrhosis and end-stage kidney disease

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