A young boy with joint pain

A concerned mother brings her 3 year old son to the family's physician after he continues to complain of pain in his bones and joints and she notices him being more lethargic, urinating more often than usual, and losing weight.



Physical/Chemical Analysis:
Color:  Yellow Protein: 3+ Blood: Negative
Appearance: Hazy Glucose: 100mg/dL Urobilinogen: Normal
Sp. Gravity: 1.015 Ketones: Negative Nitrite: Negative
pH: 5.0 Bilirubin: Negative Leukocyte: Negative

Microscopic Analysis:

0-2 RBC/hpf

0-2 squamous epithelial cells                                                Clinitest: Negative

Uric Acid crystals


                        Uric Acid crystals                            Squamous Epithelial Cell

After seeing these results, the physician ordered more tests that found high levels of bicarbonate, potassium, phosphate, and sodium in the urine.


Questions:

1)  What is a possible diagnosis for this patient? Answer

2)  What is the most likely cause of this syndrome? Answer

3)  Explain the discrepancy between the glucose stix result and clinitest? Answer

4)  What is the most likely reason for the presence of the squamous epithelial cells? Answer

5)  What are the signs and symptoms of dehydration? What is causing it in this case? Answer

6)  Are there any other confirmatory tests the physician could have ordered? Answer

7)  How should this boy be treated? Answer




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