A 17-year-old male presents with confusion and drowsiness for 1 day.
He has been healthy and playing in the high school basketball team for the last 2 years. His practice sessions always included 10 minutes of intense work followed by a period of rest or decreased activity. He also had complaints of dark urine which the previous doctor diagnosed as dehydration and was asked to drink more water.
He recently started a football club and has been playing football in addition to basketball. He has had oliguria for 4 days. Vitals are BP 124/86 mm of Hg, HR 85 b/min. Pupils are non dilated and reactive to light equally bilaterally. The remainder of the physical examination is within normal limits. Lab work shows:
BUN: 60 mg/dl
Creatinine: 4mg/dl
pH: 7.3
Anion gap: 20
Serum ketones: High
What is the most likely cause of the patient's diagnosis?
1. Pigment deposition in kidneys due to enzyme defect
2. Hemolysis due to defective hemoglobin
3. Defect in converting fatty acid chains into energy
4. Consumption of a drug
-Written by Shashi
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