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A 68-Year-Old Man Comes to the Emergency Department Due to Abdominal

question 23

Multiple Choice

A 68-year-old man comes to the emergency department due to abdominal pain and nausea for the past 2 days.  He has a history of atherosclerotic cardiovascular disease and underwent coronary artery bypass surgery 2 years ago.  Blood pressure is 105/65 mm Hg and heart rate is 120/min and irregular.  Abdominal examination reveals mild diffuse tenderness and decreased bowel sounds.  Laboratory studies are as follows: A 68-year-old man comes to the emergency department due to abdominal pain and nausea for the past 2 days.  He has a history of atherosclerotic cardiovascular disease and underwent coronary artery bypass surgery 2 years ago.  Blood pressure is 105/65 mm Hg and heart rate is 120/min and irregular.  Abdominal examination reveals mild diffuse tenderness and decreased bowel sounds.  Laboratory studies are as follows:   ECG shows absent P waves and an irregular rate and rhythm.  CT scan of the abdomen reveals colonic wall thickening and no enhancement with intravenous contrast.  Urinalysis shows acidic urine.  Renal metabolism of which of the following amino acids is most important for maximizing acid excretion in this patient? A) Alanine B) Arginine C) Aspartate D) Glutamine E) Histidine ECG shows absent P waves and an irregular rate and rhythm.  CT scan of the abdomen reveals colonic wall thickening and no enhancement with intravenous contrast.  Urinalysis shows acidic urine.  Renal metabolism of which of the following amino acids is most important for maximizing acid excretion in this patient?


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