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:::一般內科 > 個案導向學習 > Anuria > Pre-test and Case presentation

Pre-test and Case presentation

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更新日期 2022/9/16 18:41:07
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Please click this link for pretest.請點選此連結進行前測。

Chief complaint
Poor appetite for 3-4 days, and no urine output for 2-3 days

Present illness
This 62-year-old man worked as construction worker. He takes medication for hypertension and diabetes at LMD nearby. According to his statement, blood test was followed at LMD quarterly, but he forgot the results.
This time, he had poor appetite in these 3-4 days, and no urine output for 2-3 days. No fever, no URI symptom, no pain or burning sensation while urination, and no abdominal fullness or pain was told. He still took DM medication yesterday. He went to LMD, where severely deteriorated renal function was told. Therefore, he was taken our ED for medical attention.

Past history
Type 2 diabetes mellitus for 10 years, treated with basal insulin plus oral hypoglycemic agents in fair-controlled condition, recent HbA1C:6.7%.
Hypertension for 10 years

Personal History
Smoking: Nil
Alcohol: Nil
Betel nut: Nil
Drug history
Metformin 750mg BID, Saxagliptin 2.5mg QD, Insulin Glargine 30U QD, Valsartan 80mg QD

Travel history
No

Allergy history
Drug : Nil
Food : Nil
Blood transfusion : Nil

Family history
Significant disease history in the family: Nil

Contact History
No

Physical Examination                          
On examination, bilateral lower limbs edema 2+ was noted.

Laboratory Data
Lab data collected upon arrival of ED showed severe hypoglycemia, hyperkalemia (K 7.5mEq/L), leukocytosis, and high serum lactate. Elevated BUN 115 mg/dl and creatinine 12.73mg/dl was also noted.

Figure 1. Lab data
Figure 1. Lab data

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