Academic journal article Journal of College Science Teaching

Grandma's Tum-My Trouble: A Case Study in Renal Physiology and Acid-Base Balance

Academic journal article Journal of College Science Teaching

Grandma's Tum-My Trouble: A Case Study in Renal Physiology and Acid-Base Balance

Article excerpt

An elderly woman who lives in her own home under die care of her family is brought to the emergency department because she is confused and vomiting. The physician (and the students, as they work through the case) determines, from certain laboratory values, that blood pH and electrolytes have been disrupted, which has led to the patient's confusion. The role of the kidneys in regulating both is the focus of die learning objectives, but concepts related to pharmacology and therapeutics (e.g., the difference between over-the-counter and prescription medications and the importance of taking any medication carefully) are introduced.

This case has been used near the end of a second-semester Human Anatomy and Physiology course sequence. It is assumed that students have been introduced to concepts including acids and bases; kidney function and the formation of urine; acidosis and alkalosis, and the roles of the respiratory and renal systems in regulation of internal pH; and bone physiology and endocrine regulation of calcium in plasma.


In working through this case study, students should be able to:

* identify the three processes that are involved with urine formation--filtration, reabsorption and secretion--and identify the places in the nephron where they happen;

* outline the main mechanisms by which the kidney regulates pH in the body, and discuss the roles of specific transporters for [H.sup.+] and HC[O.sup.-.sub.3] in pH regulation;

* discuss the interrelated roles of the nervous system, the respiratory system, and the renal system in regulation of pH in the body;

* outline the mechanisms by which the kidney regulates plasma electrolyte concentrations, with special emphasis on plasma [Ca.sup.++] including the pertinent hormones involved;

* identify disturbances in plasma electrolytes and pH, given the appropriate reference values; and

* identify possible causes of these disturbances.

Additionally, the case provides a starting point for health care discussions by introducing some basic principles of pharmacotherapy (e.g., What is a drug? Why do drugs have potentially dangerous effects? Why are some people more susceptible to potentially adverse effects of otherwise safe medications?) and highlights the danger of drug-drug interactions.

Classroom management

This case was initially introduced as an interrupted case, with individual parts used in class by small groups. The case was used near the end of a two-semester Human Anatomy and Physiology course sequence, during the time when renal physiology was under study. Groups of two to three students were given die case and associated information (lab values, etc.). Students were also allowed access to internet resources (usually via smartphones) for any additional information they might need. Fifteen to 20 minutes were allowed for students to read the case and answer the associated questions, followed by a whole-class discussion. Discussion of the case and questions was interspersed throughout the lecture material over the course of 2 to 3 days.

Case Study

Part I: At the hospital

"Something is wrong. My mother is sick and very disoriented," explained Bobby Burroughs, a middle-aged man who was looking very anxious as he spoke with staff in the Emergency Department (ED) where he had brought his mother, Arlene Burroughs, an 83-year-old White woman.

"She's disoriented and lethargic, and she has been vomiting and complaining of an upset stomach," he said to the triage nurse who examined Mrs. Burroughs. The nurse noted that Mrs. Burroughs did not have a fever or any other signs of infection but that she did appear to be dehydrated.

The attending physician in the ED ordered a battery of tests. "I'm especially concerned about her kidney function," he told Bobby.

"I don't understand," said Bobby. "Shouldn't you be looking at her brain? …

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