Creatinine Case Summary

Doppler pulses for her lower right leg are very weak and absent in her right foot. Doppler pulses for her left leg are present (no mention of strength) and weak in her left foot. Pathology results, either from admission to prior too, show Mrs Jones has a serum creatinine level of 221mmol (potentially indicating renal failure (…) )and a blood glucose level of 29.8mmol. Elevated levels of creatininne indicate a lower glomerular filtration rate (the flow rate at which fluid is filtered through the kidneys) and as a result a decreased capability of the kidneys to excrete waste products. Mrs Jones morning finger-prick blood sugar level was

I was well versed with the patient’s medical history and current treatment, as I was the Long Call IM PGY – II Resident who supervised the medical intern when this patient was being downgraded from the ICU to the medical floor on 5/20/17 (and even suggested to the medical intern to add in her notes that the patient would benefit from statins, ACE inhibition and Spironolactone given CAD, CVA and HFrEF (LVEF < 35%.) The medical team subsequently started the patient on Atorvastatin 40 MG PO QHS, Lisinopril 10 MG PO QD and Spironolactone 12.5 MG PO QD.

R (recommendation): Do you want to continue with the current care plan continued with frequent CBS and potassium monitoring?

In transport, patient received O2 at 4 liters via nasal cannula, baseline EKG, Normal Saline IV started in left hand, 325 mg aspirin by mouth (po). Patient complained she was short of breath and experiencing severe pain between her shoulder blades. She stated that she has been feeling nasuseated for the past 3 hours. She states she has a history of stable angina and is currently taking medication as needed. She states she did not take the nitroglycerin because she was not experiencing chest pain, just back pain. She states that her last check-up with the Pulmonologist showed that her EKG did not show any changes since her last visit. She denies episodes of syncope. The patient does report that she tripped over something on the floor, which resulted in her falling and hitting her back on a large table. In addition, she states that her heart rate has been ranging from 130/ 90 to 140/92. Patient states her Primary care physician placed her on blood pressure medication 2 months ago due to the increase.

My patient is a 58-year-old female, who presents with controlled type II diabetes, hypertension, and possibly thyroid tumors that have been there for a few years. She is under the care of a physician for her diabetes and associated controlled hypertension. I recommended several times that she see her physician after feeling the tumors around her neck and thyroid. Her medical history also indicates that she had rheumatic fever twelve to thirteen years ago, has arthritis in her knees, and occasional headaches. She is 5”3 and weighs 216 pounds. Her blood pressure was 126/80, pulse was 88 BPM, respirations were 20, and her temperature was 98.2 Fahrenheit. She doesn’t smoke and I made sure that she had eaten lunch and wasn’t hungry. She is currently on 100 mg Metformin for her diabetes, 120 mg. Lisinopril for hypertension, 40 mg. of Lovastatin to lower cholesterol, 80 mg. of Aspirin to prevent cardiovascular disease, and daily insulin. Reviewing her medical HX, I was informed that she usually checks her blood glucose daily, but had recently run out of strips, so it had been a

The patient Matt is a 19-year-old Caucasian male that was admitted to the unit and being treated for lethargy, excessive thirst, recent unexpected weight loss, fever and frequent urination. Patient is uninsured, a college athlete (runs 3-5 miles a day on the cross country team), works 16 hours a week on the night shift, lives with five of males and says his diet consist of fast food, prepackaged meals and admits to having 3-4 beers, 3-4 day a week and has an allergy to penicillin (hives) and sulfa drugs. Patient was treated for a UTI once 3 months ago. The patient’s current vital signs are: temperature of 101.6F, heart rate of 99, respiratory rate of 22, blood pressure of 119/76, SaO2 99% on

VG is a thirty-one-year-old female who comes in for a routine follow-up. She reports that she has been feeling excessive fatigue over the last month. She also notes that she is having some problems at work, not only because of her fatigue but also because of difficulty concentrating. She also notes that she has gained 10 pounds over the last month, and she is unable to identify the cause of the weight gain. She also notes that her periods are a little heavier and more irregular. She is currently taking daily ferrous sulfate and over-the-counter calcium. According to VG’s medical record, she had a TSH level of 4.2 mIL/L about a year ago. Although, Her previous blood levels were slightly elevated, VG’s previous medical provider did not schedule retesting as, no further follow-up lab was deemed necessary at the time. Repeat blood work today reveals a TSH level of 9.8 mIL/L and a free T4 of 0.72 ng/dL.

Mrs. P is a 63-year-old female who was not feeling well for a couple of weeks. She went to her Primary Care Physician (PCP) complaining of increased dyspnea on exertion, weakness, nausea, headaches, loss of appetite and periods of confusion. Since she has an extensive medical history that included pulmonary hypertension and emphysema, blood work was obtained. She was told that she had leukocytosis, hyponatremia (Sodium 126 mEq/L ), hypokalemia (Potassium 2.5 mEq/L) and an acute kidney injury (AKI). She was told to go to the emergency room and was admitted to the telemetry unit.

When taking into consideration how these two medications are execrated and Mrs. S poor creatinine clearance I would choose medication B. In patients with poor creatinine clearance medications that have under majority of their elimination in the kidney such as drug A have the risk of retention. This would result in these medications being active in the body long and increase chances of

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

She had started fenofibrate 250 mg monotherapy for her high lipids and candesartan silexitil + hydrocholorothyazide16/12.5 mg for hypertension four weeks previously. Lab results were positive for urinary red blood cells, hemoglobin, and myoglobin, with plasma levels of creatinine, alanine aminotransferase, aspartate aminotrasferase, creatinine kinase, creatinine kinase myocardial b, lactate dehydrogenase, and blood urea nitrogen all significantly elevated from normal.2(p927-928) Given significant markers of renal injury, she was admitted, the myoglobin and myalgia indicating rhabdomyolysis as the possible cause. Tahmaz et al reported that hydration and discontinuation of the fenofibrate therapy caused her symptoms to cease and her lab results to return to

After the patient had present with the above signs and symptoms, further investigation was required and so was subsequently ordered by the clinician. These further tests consisted of; Blood film, taken from the vessels of the patient and analysed using light microscopy. Plasma Urea, also obtained via a blood sample from the patient which investigates the levels of Blood Urea Nitrogen to rule out renal complications. Microbiological CFU dipstick, placed into a sample of the patients urine to determine whether any urinary tract infection was present and which microorganism may be the cause (if present). Total Protein obtained from a patient’s blood sample, which can highlight any increases in Albumin and Globulin proteins outside of a normal range and so can indicate abnormal synthesis of proteins, and finally a Bone Marrow Biopsy, to investigate any possible abnormalities of the cells contained in the patient’s bone marrow. The patient also received numerous CT

The patient does have gastroesophageal reflux disease. He does take omeprazole 20 mg daily. He tells me if he skips a day, he can definitely feel it the following day, and he does feel he needs to continue with this on a

For the purpose of confidentiality, the patient will be identified by the initials A. S. A.S was a 52- year old African American woman who was admitted to the hospital when she started to experience severe urinary retention and shortness of breath. She has three adult children and eight grandchildren, but recently lost her husband of 25 years to diabetes. The patient appears to be very independent because she lives alone in her home and is aware of the disease process. She has a past medical history of acute renal

First goal: Patient will verbalize understanding of the importance of follow her heart medication regime as doctor prescribed it and describe the possible consequence of a non-compliance with her treatment by the end of her today’s appointment.