Patient Encounter Part 4

The patient returns to your clinic 1 year later for routine follow-up. She has no complaints at this time.

Current Meds: Furosemide 80 mg orally daily; lisinopril 40 mg orally daily; meto-prolol 75 mg orally twice daily; insulin glargine 28 units subcutaneously at bedtime; insulin lispro subcutaneously per sliding scale with meals; darbepoetin 60 mcg subcutaneously weekly

ROS: Unremarkable PE:

VS: BP 128/75 mm Hg, P 68 bpm, T 36.5°C (97.9°F); wt 77.3 kg (170 lb) Chest: RRR, normal Si, S2 present

Abd: Obese; no organomegaly, bruits, tenderness, (+) bowel sounds; heme (-) stool

Exts: 2+ edema bilaterally; decreased sensation to light touch in feet; no lesions

Labs: Sodium 144 mEq/L (144 mmol/L); potassium 5.0 mEq/L (5.0 mmol/L); chloride 105 mEq/L (105 mmol/L); carbon dioxide 18 mEq/L (18 mmol/L); BUN 75 mg/ dL (26.78 mmol/L urea); SCr 4.8 mg/dL (424 pmol/L); glucose 115 mg/dL (6.38

mmol/L); calcium 8.6 mg/dL (2.15 mmol/L); phosphate 7.8 mg/dL (2.52 mmol/L); albumin 3.0 mg/dL (30 g/L); intact parathyroid hormone (iPTH) 538 pg/mL (538 ng/L or 57.6 pmol/L); WBC 6.0 x 103 cells/mm3 (6.0 x 109/L); RBC 3.5 x 106 cells/mm3 (3.5 x 1012/L); Hgb 10.5 g/dL (6.51 mmol/L); Hct 32% (0.32); platelets 350 x 103 cells/mm3 (350 x 109/L)

What signs are consistent with secondary hyperparathyroidism (sHPT)? How would you determine whether treatment is necessary for this patient? What treatment would you recommend for sHPT?

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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