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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Assess a patient's kidney function based on clinical presentation, laboratory results, and urinary indices

  • Identify pharmacotherapeutic outcomes and endpoints of therapy in a patient with acute kidney injury (AKI)

  • Apply knowledge of the pathophysiology of AKI to the development of a treatment plan

  • Select pharmacotherapy to treat complications associated with AKI

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PATIENT PRESENTATION

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Chief Complaint

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"Mom just hasn't been acting like herself for the last few days."

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History of Present Illness

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Geraldine Lowry is an 84-year-old Caucasian woman with altered mental status who was brought to the emergency department (ED) by her daughter. She was discharged from the hospital 1 week ago following treatment for an exacerbation of her chronic heart failure. The patient's history of present illness has been relayed by her daughter, as the patient is unable to provide a history at this time. According to the daughter, GL initially felt less fatigued and short of breath following her hospital discharge, which she attributes to the increased dose of her "water pill" that GL has continued to take since her hospital discharge. Her daughter, who is her primary care giver, has noticed that GL has become progressively more confused and lethargic over the last few days. Today, the patient became very dizzy and lightheaded when trying to stand up, and her daughter decided to bring her to the emergency department.

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Past Medical History

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Heart failure × 5 years

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DM type 2 × 15 years

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HTN × 30 years

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Osteoarthritis × 35 years

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Chronic kidney disease × 7 years

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Diabetic gastroparesis, diagnosed 6 months ago

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Family History

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Father died of MI at the age of 67 and mother died of breast cancer at the age of 82. Brother has been diagnosed with CAD and has a history of MI and is alive at age 78.

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Social History

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Retired, worked as an elementary school teacher for 25 years. Married for 51 years, widowed 7 years ago. Currently lives with daughter.

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Tobacco/Alcohol/Substance Use

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(−) Alcohol, tobacco, or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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Macrolide antibiotics (hives)

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Medications (Prior to Admission)

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Lisinopril 20 mg PO q 24 h

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Metoprolol 50 mg PO q 12 h

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Furosemide 40 mg PO twice daily

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Metformin 500 mg PO twice daily

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Sitagliptin 100 mg PO q 24 h

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Ibuprofen 200 mg PO three times daily PRN pain

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Multivitamin PO q 24 h

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Metoclopramide 10 mg PO with meals and ...

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