临床药学肾病专业临床案例试题.docVIP

CaseNum 96 PtName Don White Address 939 Field Drive Age 33 Height 5 8 Weight 140 lb Sex M Race White Allergies NKDA SectionName Renal Disorders CaseName Renal Failure (Chronic) ChiefComplaint DW, a 33-yo male, presents to the diabetes clinic for a follow-up outpatient appointment. HxPresIllness Eight weeks ago, DW was discharged from the hospital with diagnoses of silent MI, pulmonary edema (resolved), severe HTN, and renal insufficiency. Before this hospitalization, DW had not seen a physician in a year. A cardiac catheterization was postponed until renal function stabilized. PastMedicalHx DW has had type 1 DM for 20 years and has been hospitalized approximately ten times for DKA. Diabetic complications include diabetic retinopathy, nephropathy, gastroparesis, and mildperipheral neuropathy. DW states that he does have a blood glucose meter, but that it has been broken for awhile. Also, DW has been hypertensive for approximately 5 years. DWs past surgical history is significant for retinal laser photocoagulation 2 weeks ago. SocialHx Remote smoking history 1 ppd x 2 years, but has not smoked in 10 years. DW is a salesman. He drinks alcohol socially. He denies any illicit drug use. FamilyHx Father with MI at age 49, (+) hypercholesterolemia, (-) diabetes ReviewOfSystems DW has noted some lower extremity edema. He denies orthopnea, palpitations, syncope, angina, or dyspnea on exertion. PhysicalExam GEN: Pleasant white man in NAD who is A O x 3. VS: BP 155/95 mmHg, HR 70 bpm, RR 12 rpm, T 98.8°F, Wt 64 kg HEENT: NC/AT, moist oral mucosa with poor dentition, thyroid WNL, no carotid bruits detected CHEST: Clear to auscultation CV: RRR, no m/r/g ABD: Positive BS, no hepatosplenomegaly EXT: 2+ pretibial edema on lower extremities, calluses on bottom of both feet, decreased sensation bilaterally to 5.07 monofilament LabsAndDxTests Sodium 133 mEq/L Potassium 5.4 mEq/L Chloride 105 mEq/L CO2 content 22 mEq/L BUN 58 mg/dL Serum creatinine 3.7 mg/dL Glucose 456 mg/dL Calcium