IDENTIFICATION AND HISTORY
This patient is a 67-year-old Mexican-American female. She was admitted to the hospital early this morning at approximately
0400 hours. She was seen in the emergency room at approximately 3 a.m. because of diaphoresis and weakness, with subsequent diagnosis of hypoglycemia. She was admitted to the hospital and placed in the progressive care unit. She was admitted with a hemoglobin of 6.9 and a potassium of 6.2, with evidence of renal insufficiency.
0400 hours. She was seen in the emergency room at approximately 3 a.m. because of diaphoresis and weakness, with subsequent diagnosis of hypoglycemia. She was admitted to the hospital and placed in the progressive care unit. She was admitted with a hemoglobin of 6.9 and a potassium of 6.2, with evidence of renal insufficiency.
It should be noted that she has been admitted to the hospital in the past because of chronic renal insufficiency and hyperkalemia. This resulted in a program which included DiaBeta 5 mg b.i.d., Inderal 20 mg 3 times a day. Quinidex Extentabs 1 b.i.d., and ferrous sulfate.
IMPRESSION
1. Diabetes mellitus, type 2.
2. Hypoglycemia secondary to oral hypoglycemic agents in the face of renal insufficiency, leading to hypoglycemia.
3. Hyperkalemia, acute, secondary to her renal insufficiency and being on angiotensin-converting enzyme inhibitors.
RECOMMENDATIONS
1. Discontinue her Vasotec.
2. Hydration with saline since I think at least part of her renal failure is probably on the basis of prerenal azotemia secondary to her furosemide therapy.
3. Sodium bicarbonate for treatment of her metabolic acidosis.
4. Kayexalate p.o. and Kayexalate enemas.
5. Glucose infusion followed by regular insulin.
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