Rural Emergency Medicine

This weeks case comes from Clinical Correlations.

Presenting Complaint
Mr K a 59 year-old male comes into your clinic feeling quite fatigued and lethargic with some mild vomiting in recent days.

Past Medical History
Mr K, is a patient of another doctor in your clinic, so you look up his history. Mr K, has a history of hypertension, non-insulin dependent diabetes mellitus, dyslipidemia and worsening chronic kidney disease (CKD) over the last 6 years. When asked he says he has been complying with his medications and treatment regime to control his blood pressure and glucose, yet his condition has continued to deteriorate.  His current medication regimen includes metoprolol, hydrochlorothiazide, aspirin, simvastatin, glyburide, and monopril.

Some blood tests are ordered;
Serum creatinine - 1.7mg/dl
Potassium - 4.6mmol/l   (NR: 3.5 - 5.0)
Sodium - 141mmol/l   (NR: 135 - 145)
Magnesium - 1.7mg/dl   (NR: 1.7 - 2.2)
Calcium - 9.4mg/dl    (NR: 8.5 to 10.2)
Phosphate - 3.5mg/dl   (NR: 2.7 - 4.5)
HgA1c - 7.1%

His calculated GFR (via the Cockroft Gault formula) is 50ml/min, meeting the definition of Stage 3 CKD.

So on the whole his metabolic status is within normal ranges. However, are there no other tests that may be ordered to ensure the best care is being provided to Mr K.  To find out click here.

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