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1、CaseNum96PtNameDonWhiteAddress939FieldDriveAge33Height5'8"Weight140lbSexMRaceWhiteAllergiesNKDASectionNameRenalDisordersCaseNameRenalFailure(Chronic)ChiefComplaintDW,a33-yomale,presentstothediabetesclinicforafollow-upoutpatientappointment.HxPresIllnessEightweeksago,DWwasdischargedfromtheh
2、ospitalwithdiagnosesofsilentMI,pulmonaryedema(resolved),severeHTN,andrenalinsufficiency.Beforethishospitalization,DWhadnotseenaphysicianinayear.Acardiaccatheterizationwaspostponeduntilrenalfunctionstabilized.PastMedicalHxDWhashadtype1DMfor20yearsandhasbeenhospitalizedapproximatelytentimes
3、forDKA.Diabeticcomplicationsincludediabeticretinopathy,nephropathy,gastroparesis,andmildperipheralneuropathy.DWstatesthathedoeshaveabloodglucosemeter,butthat"ithasbeenbrokenforawhile."Also,DWhasbeenhypertensiveforapproximately5years.DW'spastsurgicalhistoryissignificantforretinallaserphoto
4、coagulation2weeksago.SocialHxRemotesmokinghistory1ppdx2years,buthasnotsmokedin10years.DWisasalesman.Hedrinksalcoholsocially.Hedeniesanyillicitdruguse.FamilyHxFatherwithMIatage49,(+)hypercholesterolemia,(-)diabetesReviewOfSystemsDWhasnotedsomelowerextremityedema.Hedeniesorthopnea,palpitati
5、ons,syncope,angina,ordyspneaonexertion.PhysicalExamGEN:PleasantwhitemaninNADwhoisA&Ox3.VS:BP155/95mmHg,HR70bpm,RR12rpm,T98.8°F,Wt64kgHEENT:NC/AT,moistoralmucosawithpoordentition,thyroidWNL,nocarotidbruitsdetectedCHEST:CleartoauscultationCV:RRR,nom/r/gABD:PositiveBS,nohepatosplenomegalyEXT
6、:2+pretibialedemaonlowerextremities,callusesonbottomofbothfeet,decreasedsensationbilaterallyto5.07monofilamentLabsAndDxTestsSodium133mEq/LPotassium5.4mEq/L15Chloride105mEq/LCO2content22mEq/LBUN58mg/dLSerumcreatinine3.7mg/dLGlucose456mg/dLCalcium8.5mg/dLPhosphorus4.7mg/dLAlbumin2.2g/dLHgbA
7、1c12.0TSH3.05Hgb12.2g/dLHct36.1%Platelets223,000/mm3WBC6900/mm3Urineanalysis:ColoryellowSpecificgravity1.015Blood3+Protein3+pH5.0GlucosetraceUrinecollection24hours:Urinecreatinineclearance25mL/minUrinetotalprotein17.7g/24hLipidpanel(fasting):TChol336HDL30LDL221VLDL8
