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43 years old female patient, her longstanding history of diabetes and hypertensi

ID: 126084 • Letter: 4

Question

43 years old female patient, her longstanding history of diabetes and hypertension and present with some of condition of pruritis, lethargy, lower extremity edema, nausea and emesis.. Blood pressure 178/109, pulse 79, respirations 23 and she had afebrile, and Body weight 75.4 kg. Her Doctor orders basic metabolic panel with complete blood count to get more understanding about her complication.

What is the diagnosis for the patient described and a description of the appropriate treatment protocol for that clinical condition

Chemistry

Patient value

Reference ranges

Sodium

130

136-144 mmol/L

Potassium

6.3

3.7-5.2 mmol/L

Chloride

102

101 -111 mmol/L

Total CO2

13

20-29 mmol/L

BUN

150

7-20 mg/dl

Creatinine

15.0

0.8 - 1.4 mg/dl

Glucose

108

64-128 mg/dl

Calcium

6.2

8.9-10.3 mg/dl

Phosphorus

10.3

2.6-6.4 mg/dl

Alkaline Phosphatase

303

30-110 IU/L

Parathyroid Hormone

884

10-65 pg/ml

Hemoglobin

8.5

14-17 gm/dl

MCV

80

80-100fL

Hematocrit

27.3

40-54%

Chemistry

Patient value

Reference ranges

Sodium

130

136-144 mmol/L

Potassium

6.3

3.7-5.2 mmol/L

Chloride

102

101 -111 mmol/L

Total CO2

13

20-29 mmol/L

BUN

150

7-20 mg/dl

Creatinine

15.0

0.8 - 1.4 mg/dl

Glucose

108

64-128 mg/dl

Calcium

6.2

8.9-10.3 mg/dl

Phosphorus

10.3

2.6-6.4 mg/dl

Alkaline Phosphatase

303

30-110 IU/L

Parathyroid Hormone

884

10-65 pg/ml

Hemoglobin

8.5

14-17 gm/dl

MCV

80

80-100fL

Hematocrit

27.3

40-54%

Explanation / Answer

Medical diagnosis:

-Hyperparathyroidism causing hyperphosphatemia and hypocalcemia and high ALP levels.

- ? Acute on chronic Renal failure causing hyperkalemia

-Anaemia secondary to chronic kidney disease

Appropriate treatment would be hemodialysis of this patient and find the cause of hyperparathyroidism and do the management accordingly.

The commonest cause is parathyroid adenoma which is a benign condition and can be corrected with excision surgery.

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