A CASE STUDY ON Chronic renal failure

Chief complaint: A 58 years old widow with a chief complaint of episodes of

restlessness and anxiety over the last week; weight has increased by approximately

S 2 kg (5lb) since last appointment.

History of present illness: Scheduled for outpatient follow-up every 3 months; has
missed the last 2 regular appointments; last evaluation 9 months ago (fasting blood
glucose 150 mg/dL, Cr 1.8/dL, bP 138/82, UA 100 mg protein in 24 hours)-glipizide
dose was increased from 35 mg/day to 40 mg/day; reports blood sugars at home
130-180 mg/dL; medication adherence verified by daughter

Medical history:

Past medical history: Type 2 diabetes mellitus x 10 years; migraine headaches-1 episode every 2-3
months (last episode 6 months ago)

Past surgical history: Hysterectomy 5 years ago

Medications: Glipizide, 20mg PO BID(2 years, current dose x 9 months), Sumatriptan, 1 injection SC PRN,
Conjugated estrogen, 0.625 mg PO QD (5 years)

Allergy: Sulfa, unknown reaction

Family History: Mother- Type 2 DM; father-died age 53 of MI

Social History: Smoker-25 pack-year history; no alcohol use

Gen.: Well-developed, well-nourished female in no acute distress

Vitals: BP 148/84 (sitting) RR 15 HR 92 Temp 37.1°C

O Wt.: 70.3 kg (68 kg at last visit)

HEENT: Retinal edema, punctuate hemorrhages

Ht.: 163 cm

COR: WNL

CHEST: WNL

ABD: WNL

GU: WNL

RECT: WNL

EXT: WNL

NEURO: WNL

WBC with differential: WNL

Assessment:

A
 1.) Avoid consumption of alcohol, because it can interfere with the positive effects of oral
diabetes medicines or insulin.

2.) Avoid stress because it may be hard to control blow sugar

3.) Type 2 diabetes may sometimes be controlled with a combination of diet, weight
management and exercise

4.) The nicotine in cigarettes makes your blood vessels harden and narrow, curbing blood
flow around your body. And since diabetes makes you more likely to get heart disease, so
therefore avoid smoking

5.) Special diets should be provided by professionals to ensure patients are properly
assessed and that the education and management provided is appropriate to them.

6.) A low-protein diet should not be offered as this can lead to malnourishment if
sustained over a long period. Renal teams must monitor and manage kidney function to
ensure symptoms are kept to a minimum; once they are unmanageable using diet and
medicines, renal replacement therapy of the patient’s choice should be started.

7.) When patients have later-stage CKD (stages 4 and 5), they must be given robust
information on treatment options. These comprise dialysis, transplantation and
conservative management. Not every option will be appropriate for every patient;
suitability will be determined by the patient’s physical and mental condition.

Plan:

P 1.) Continue glipizide 20 mg PO BID

2.) Eliminate sumatriptan, 1 injection SC PRN. Or you can take the tablet form of sumatriptan
when needed.