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?

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