Sarah, a 63-year-old female with a past medical history significant for diabetes mellitus, cirrhosis, gout and a 30-pack a year smoking history presents to the emergency room with chest pain revealing pericarditis in the echocardiogram. Secondary to recently diagnosed end-stage renal disease. Physical examination reveals yellowish discoloration to the skin and sclera, multiple bruises, 2+ bilateral edema, and weakness lasting more than three weeks. Her medications include Glisten, a new drug for diabetes that causes ATP sensitive potassium channels to close, thereby releasing insulin. Her recent laboratory results are as follows: 

  

1. Explain the cause for her low calcium and sodium levels. 

2. Explain the cause of her anemia. What laboratory test should indicate she is suffering from anemia?

3. Explain the cause of her hypotension. How will her body attempt to establish homeostasis?

4. What type of acid-base disorder has she developed, and how will her body compensate?

5. Explain the cause of her elevated ADH and glucose levels.

6. What is the correlation between her illnesses and the low vitamins (D, K, E, and A), renin, and aldosterone levels?

7. Which hormone would the body elevate in response to her low calcium levels? Why?

8. Explain the physiological reason behind her physical findings (yellowish hint of the skin, sclera, multiple bruises, weakness, and edema).

9. Explain the cause of her abnormal stool and urine sample. 

10. What cell does Glisten work on? Explain how this medication is able to stimulate insulin secretion.

CBC Sodium 126 mEg/L 220 mmol/L 7.1 mg/dl Glucose Calcium Red blood cell count 3.9 cells/ul Vitals Blood Pressure 92/64 mmHg Blood Gases pH CO2 7.28 30 mmHg 12 mmol/L Hormone Panel HC03 Low Elevated Low Renin ADH Aldosterone Vitamins Vit D Vit K Vit E Vit A Low Low Low Low Urine and Stool Sample Gray Stool color Stool content Urine color Increased Fat Content White