David is a 61-year-old male admitted by his family physician to the medical unit due to a new diagno
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David is a 61-year-old male admitted by his family physician to the medical unit due to a new diagnosis of chronic renal failure and Type 2 diabetes discovered through routine bloodwork and physical exam at a physical required by his new employer. David has not seen his family doctor in 20 years. He was diagnosed with HTN 20 years ago but decided not to treat it with medications.
David denies any other medical history.
Social History
David is married and is employed as a heavy-duty mechanic. He has 3 grown children and 2 grand children. David drinks beer most evenings but never more than 2 per day. He has never smoked cigarettes. He is physically active at his job and enjoys swimming and hiking. His diet includes a lot of red meat, little green vegetables and he enjoys drinking coke. He drinks 3 to 4 cups of sweetened coffee with cream per day.
Initial impressions:
Presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis.
On physical exam the patient is a well-developed, well-nourished male in moderate distress. HEENT was remarkable for fundoscopic findings of A-V nicking and copper wire changes consistent with hypertensive injury. Cardiac exam had an S1, S2 and S4. The remainder of the exam was remarkable for 2+ lower extremity edema and superficial excoriations of his skin from scratching.
Height 175 cm
Weight 76.5 kg
BP 180/110
HR 80
RR 24
T 36.7
O2 sats – 95% on RA.
Chemistry Normal Values Urinalysis
Sodium 133 136-146 mmol/L
pH 6.0
Specific gravity 1.010
Protein 1+
Glucose negative
Acetone negative
Occult blood negative
Bile negative
Waxy casts
Potassium 6.2 3.5-5.3 mmol/L
Chloride 100 98-108 mmol/L
Total CO2 15 23-27 mmol/L
BUN 170 7-22 mg/dl
Creatinine 16.0 0.7-1.5 mg/dl
Glucose 8.6 4 – 7 mmol/L
Calcium 7.2 8.9-10.3 mg/dl
Phosphorus 10.5 2.6-6.4 mg/dl
Hemoglobin A1c 7.8% Less than 6%
Alkaline Phosphatase 306 30-110 IU/L
Parathyroid Hormone 895 10-65 pg/ml
Hemoglobin 86 140 – 170 g/L
Hematocrit 27.4 40-54 %
Mean cell volume 88 85-95 FL
24-hour urine protein and creatinine – volume 850 ml, protein 600 mg/dl and creatinine 180 mg/dl
Renal ultrasound – Right kidney 9 x 6.0 cm, Left kidney 9.2 x 5.8 cm
Both kidneys illustrate hyperechogenicity and no hydronephrosis.
Patient is allergic to shellfish.
what is the FDAR charting for this scenario?
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