CASE STUDY

Mary is a 32-year-old female who is admitted to the hospital with increased fatigue, lethargy, and occasional confusion from chronicuremia secondary to End Stage Renal Disease (ESRD). Mary has a long history of diabetes mellitus resulting in damage to her kidneys. Diagnostic tests ordered for Mary include:

1. renal ultrasound
2. Hgb and Hct
3. BUN and serum creatinine
4. creatinine clearance (CrCl)
5. serum electrolytes
6. urinalysis
7. finger prick for fasting blood sugar and blood draw for HbA1C

Mary's renal status has continued to deteriorate. Creatinine clearance is 6 ml per minute. Mary is showing evidence of fluid intoxication despite conservative measures to restrict fluid. BP 160/96, weight started at 120 lbs. and has increased by 5 lbs. since admission, 2+ pitting edema noted in her ankles and feet, fine crackles are present bilaterally in bases of lungs on auscultation, O2 sat is 92%, heart rate is 92, jugular vein distention is evident. Her fasting blood glucose is 230 mg/dl and her HbA1C is 13.4.

Mary's doctor has prepared her for the possibility of hemodialysis.

QUESTIONS

1. Explain fasting blood glucose and HbA1C. In your explanation include how the two tests differ, what the normal lab ranges are, and what abnormal results indicate.
2. What happens if too much fluid is removed during dialysis?
3. What type of dialysis should Mary be placed on, and what is your medical rationale?

DIRECTIONS

To post your response to the questions below, click on START A NEW THREAD, give your response a title, and then type your response in the box provided. Once done, check your spelling, then click on POST at the bottom of the page.

1. Answer every question in full sentences, starting with a Capital letter and ending with the proper punctuation. Now is not the time to "text speak." Check your grammar and spelling.
2. For Ques 1. You can answer this starting with a complete sentence. Full paragraph more than 5 sentences is expected.
3. For Ques 2. Answer this question in a complete paragraph with a minimum of 5 sentences. The more in-depth you go, the more points you will earn.
4. For Ques 3. Explain what type of dialysis you would put Mary on, and then give your medical rationale for choosing that method. Answer in a complete paragraph with a minimum of 5 sentences. The more in-depth you go, the more points you will earn.