醫療類申論題
109年
[獸醫師] 獸醫實驗診斷學
第 一 題
一、一歲的母拉布拉多犬，有嗜睡、抑鬱、共濟失調、嘔吐、脫水及乏尿。請由下列血液學、血清生化學、尿液及血液氣體數據，判讀各種異常的數值及其所代表的臨床意義。（25 分）
| 血液學檢查 | | |
| --- | --- | --- |
| Hct | 56.5 | % |
| Hb | 18.6 | g/dL |
| RBC | 7.93 | ×10⁶/μL |
| MCV | 71.3 | fL |
| MCH | 23.5 | pg |
| MCHC | 32.9 | % |
| RBC 形態：正常 | | |
| Platelets： | 357 | ×10³/μL |
| WBC | 29.7 | ×10³/μL |
| Seg | 26.433(89%) | ×10³/μL |
| Band | 2.079(7%) | ×10³/μL |
| Lymph | 0.594(2%) | ×10³/μL |
| Mono | 0.594(2%) | ×10³/μL |
| Eos | 0.0 | ×10³/μL |
| Baso | 0.0 | ×10³/μL |
| WBC 形態：正常 | | |
| 血清生化學檢查 | | |
| --- | --- | --- |
| BUN | 75 | mg/dL |
| Creatinine | 5.7 | mg/dL |
| Total Protein | 8.2 | g/dL |
| Albumin | 3.1 | g/dL |
| A/G ratio | 0.61 | |
| ALP | 83 | U/L |
| ALT | 28 | U/L |
| Glucose | 141 | mg/dL |
| Sodium | 143 | mmol/L |
| Potassium | 5.5 | mmol/L |
| Chloride | 99 | mmol/L |
| Total CO₂ | 5 | mmol/L |
| Anion gap | 39 | mmol/L |
| Calcium | 8.6 | mg/dL |
| Phosphorus | 10.2 | mg/dL |
| 尿液分析 | | |
| --- | --- | --- |
| 尿液來源 | 膀胱穿刺 | |
| 顏色 | 淡黃色 | |
| 混濁度 | 清澈 | |
| 比重 | 1.011 | |
| pH | 6.0 | |
| Protein | 1+ | |
| Glucose | 1+ | |
| Ketone | - | |
| Bilirubin | - | |
| Blood | - | |
| 尿沉渣 | 草酸鈣結晶 | |
| 血液氣體檢查 | | |
| --- | --- | --- |
| pH | 7.237 | |
| HCO₃⁻ | 11.5 | mmol/L |
| PCO₂ | 27.1 | mmHg |
| 血液學檢查 | | |
| --- | --- | --- |
| Hct | 56.5 | % |
| Hb | 18.6 | g/dL |
| RBC | 7.93 | ×10⁶/μL |
| MCV | 71.3 | fL |
| MCH | 23.5 | pg |
| MCHC | 32.9 | % |
| RBC 形態：正常 | | |
| Platelets： | 357 | ×10³/μL |
| WBC | 29.7 | ×10³/μL |
| Seg | 26.433(89%) | ×10³/μL |
| Band | 2.079(7%) | ×10³/μL |
| Lymph | 0.594(2%) | ×10³/μL |
| Mono | 0.594(2%) | ×10³/μL |
| Eos | 0.0 | ×10³/μL |
| Baso | 0.0 | ×10³/μL |
| WBC 形態：正常 | | |
| 血清生化學檢查 | | |
| --- | --- | --- |
| BUN | 75 | mg/dL |
| Creatinine | 5.7 | mg/dL |
| Total Protein | 8.2 | g/dL |
| Albumin | 3.1 | g/dL |
| A/G ratio | 0.61 | |
| ALP | 83 | U/L |
| ALT | 28 | U/L |
| Glucose | 141 | mg/dL |
| Sodium | 143 | mmol/L |
| Potassium | 5.5 | mmol/L |
| Chloride | 99 | mmol/L |
| Total CO₂ | 5 | mmol/L |
| Anion gap | 39 | mmol/L |
| Calcium | 8.6 | mg/dL |
| Phosphorus | 10.2 | mg/dL |
| 尿液分析 | | |
| --- | --- | --- |
| 尿液來源 | 膀胱穿刺 | |
| 顏色 | 淡黃色 | |
| 混濁度 | 清澈 | |
| 比重 | 1.011 | |
| pH | 6.0 | |
| Protein | 1+ | |
| Glucose | 1+ | |
| Ketone | - | |
| Bilirubin | - | |
| Blood | - | |
| 尿沉渣 | 草酸鈣結晶 | |
| 血液氣體檢查 | | |
| --- | --- | --- |
| pH | 7.237 | |
| HCO₃⁻ | 11.5 | mmol/L |
| PCO₂ | 27.1 | mmHg |
📝 此題為申論題
思路引導 VIP
從臨床症狀與檢驗數據出發：血液學呈現濃縮與發炎反應；生化與尿液呈現缺血等固氮血症（BUN、CREA高，但尿比重僅1.011，顯示急性腎衰竭）；血氣與電解質顯示嚴重高陰離子間隙的代謝性酸中毒。結合尿沉渣的「草酸鈣結晶」與神經症狀，可高度懷疑為乙二醇（Ethylene glycol）中毒。
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AI 詳解
AI 專屬家教
【破題】綜合臨床症狀及檢驗數據（急性腎損傷、高陰離子間隙代謝性酸中毒、草酸鈣尿結晶），本病例為典型的「乙二醇（Ethylene glycol）中毒」引發之急性腎衰竭。 【數據判讀與臨床意義】 一、 血液學異常
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