(pleаse use the cаse belоw tо аnswer the fоllowing seven (7) questions) JL, a 50 year old African American female with a history of type 2 diabetes, hypertension and chronic kidney disease (CKD) presents to clinic for routine follow up. Her estimated glomerular filtration rate (eGFR) is stable at 55 mL/minute/1.73 m2 Her fasting blood sugars have been elevated recently, averaging 200 to 250 mg/dL. PMH: Diabetes mellitus type 2 for 5 years, not currently controlled, Hypertension for 5 years, not currently controlled FH: Mother is alive at 88 with coronary artery disease; father is deceased from diabetes; no siblings SH: She does not work; smokes 1 pack of cigarettes/day, but denies alcohol or illicit drug use; she does not exercise Medications: hydrochlorothiazide 25 mg orally daily Metformin 1000 mg orally twice daily VS: Blood pressure 146/88 mmHg Height 62 inches, weight 160 lb. BMI 30 Labs : fasting plasma glucose 250 mg/dL A1C 9.5 urinary albumin excretion 60 mg/day : SCr 0.9 mg/dl
(pleаse use the cаse belоw tо аnswer the fоllowing two (2) questions) CH is a 60 year old man with stage 5 CKD and a history of calciphylaxis and uncontrolled hyperphosphatemia. His most recent laboratory results show serum calcium of 10.0 mg/dL and a phosphorus concentration of 8.6 mg/dL. He had been receiving ergocalciferol 50,000 iu po once daily. You cannot find a recent PTH level, therefore you order a PTH for the patient and in the meantime, try to lower his phosphorus concentration.