CASE LEARNING OBJECTIVES
Identify specific consequences associated with end-stage renal disease (ESRD)
Design an appropriate therapeutic approach for specific consequences associated with ESRD
Recommend an appropriate monitoring plan to assess the effectiveness of pharmacotherapy for ESRD and specific consequences
Educate patients with CKD about the disease state, the specific consequences, lifestyle modifications, and pharmacologic therapies used for treatment of CKD
"I missed my last dialysis session"
History of Present illness
Harold Palmer is a 67-year-old Caucasian male who presents to the ED with SOB and nausea. He is relatively compliant with his dialysis appointments but missed his last session because he did not have a ride to the dialysis center. His normal hemodialysis schedule is on Mondays, Wednesdays, and Fridays.
HTN: diagnosed 35 years ago
DM type 2: diagnosed 35 years ago
Dyslipidemia: diagnosed 35 years ago
CAD, h/o NSTEMI: 7 years ago
ESRD: began hemodialysis 9 months ago via left AV fistula
Father: deceased, MI at age 88 years
Mother: living in a nursing home, HTN, CKD stage 3, and Alzheimer's disease, age 90
The patient lives at home with his wife of 45 years. He is a retired plumber. He denies any tobacco use, drinks alcohol only on occasion, and denies any history of illicit drug use.
Lisinopril 40 mg PO daily
Candesartan 8 mg PO daily
Carvedilol 25 mg PO twice daily
Insulin glargine 10 units SC at bedtime
Insulin lispro per sliding scale SC before meals
Atorvastatin 20 mg PO at bedtime
Calcium acetate 1334 mg PO three times daily with meals
Multivitamin 1 tablet PO daily
Calcium carbonate/cholecalciferol 500 mg/400 IU 1 tablet PO twice daily
Ferrous sulfate 325 mg PO three times daily
No known drug or food allergies
The patient is a 67-year-old male in no acute distress. He is of normal stature with good hygiene and good affect.
BP 132/78 mm Hg, P 93 bpm, RR 12, T 37°C, pain 0
Weight: 290.4 lb (132 kg)
Dry-appearing skin. No noted scars, bruises, rashes or tattoos.