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Case 7
In this week assignment, there are two patients.
Patient 1 
A 40-year-old man (a patient with a 20-year history of alcohol abuse) is complaining about
blurred vision and headache. He has a history of hypertension and hyperlipidemia. His
hypertension is poorly controlled because of non-compliance. The patient also smokes a pack of
cigarettes a day for the past 20 years. 
VS: T 37C, P 68/min, BP 210/150 mm HG, BMI 28
PE: Patient is anxious, and complains about inability to concentrate because of headaches. The
patient is unable to provide a urine sample, A presystolic murmur is evident. Funduscopic
examination shows optic nerve swelling of both eyes. 
Laboratory tests: 
SM-12: BUN 160 mg/dl; creatinine: 8.2 mg/dl. 
Blood gas analysis (BGA): PO2 90 mm Hg; PCO2 33 mm Hg; HCO3- 12 mEq; pH 7.3
Plasma renin: 25 ng/ml/hr 
ECG: normal sinus rhythm, left axis deviation, no ST shift. 
Cardiac enzymes: normal
1) Looking at the patients symptoms, what is the initial diagnosis? Provide alternatives. 
2) Examine BGA and draw meaningful conclusions with regard to PO2, PCO2 levels, blood pH,
and hemoglobin. 
3) Explain why the patient presents with left axis deviation. 
4) Explain optic nerve swelling. 
5) Explain the significance of renin. 
6) Explain where and which cells release renin, and how does it control efferent arteriolar
resistance? 
7) Would you treat a patient with malignant hypertension with ACE inhibitors? Argue why you
would, and why you would not. Provide an alternative treatment.