CKD complications managementDownloads

You are called to a hemodialysis suite. The patient is a 61-year-old man with a history of hypertension, hypercholesterolemia, and type-2 diabetes mellitus-induced end-stage renal disease who has required hemodialysis for the past year. His current hemodialysis session is nearing the end when the nurse notices that his blood pressure has dropped to 88/60 mm Hg from his normal of 142/90 mm Hg. The patient denies any shortness of breath or chest pain. He took his daily bisoprolol, metformin, and insulin this morning before coming to the hospital. On examination, the patient’s blood pressure is 92/60 mm Hg, and his heart rate is 119/min. Chest auscultation is unremarkable. What is the most appropriate next management step?

A 42-year-old man presents to his primary care physician for a wellness checkup. The patient has a past medical history of obesity, constipation, and depression. His current medications include metformin, lactulose, and fluoxetine. His temperature is 99.5°F (37.5°C), blood pressure is 157/102 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 5,500/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 105 mEq/L K+: 3.5 mEq/L HCO3-: 21 mEq/L BUN: 20 mg/dL Glucose: 129 mg/dL Creatinine: 1.1 mg/dL AST: 12 U/L ALT: 10 U/L Urine: Appearance: Yellow Bacteria: Absent Red blood cells: 0/hpf pH: 6.8 Nitrite: Absent Which of the following is the next best step in management?