By Naomi, Rayvin, and Miranda Patient #4 By Naomi, Rayvin, and Miranda

Case study A 15-year-old female comes in for her annual physical. Her mom informs you that she is worried because the girl has been on a strict diet and has lost a great deal of weight in the past few months. She has very little energy and does not seem interested in hanging out with her friends. The girl mentions that she has been losing some hair lately and she has not menstruated over three months. Microscopic analysis of her urine does not reveal anything abnormal.

Macroscopic and Microscopic Analysis Macroscopic Analysis The urine was almost colorless and clear. Microscopic analysis No erythrocytes or leukocytes were found present.

Chemical analysis The pH was Low. The specific gravity was normal. The protein level was normal. The glucose level was normal. The Ketone level was elevated.

Low ph could indicate acidosis dehydration diabetic ketoacidosis diarrhea starvation

Elevated ketones could indicate Abnormal food or nutrition intake due to: anorexia nervosa (an eating disorder), fasting, high protein or low carbohydrate diet, starvation, vomiting over a long period Disorders of increased metabolism Acute or severe illness Burns Fever Hyperthyroidism Nursing a baby (lactation) Pregnancy

Symptoms Extreme weight loss Insomnia Abnormal blood count Thin hair or hair that falls out Dry skin Irregular heart rhythms Low blood pressure Irregular Menstruation