Week 9: Endocrine, Metabolic, and Nutritional Disorders

Week 9: Endocrine, Metabolic, and Nutritional Disorders

Week 9 Case 1: Low Blood Sugar

HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar in the morning, fasting.  She reports seeing blood sugar as low as 50 fasting in the mornings for the last few weeks.  She has a known history of Diabetes, Hypertension, Hyperlipidemia, and Chronic Osteoarthritis.  She also reports elevated blood pressures. Her blood pressure at presentation is 165/90.  

RESOURCE FOR THIS WEEK: Review endocrine-related Evidence Based Practice Guidelines.

Ms. Lewis is a 63 y/o female who is AAOX4. She makes no unusual motor movements and demonstrates no tics.  She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She denies any falls, denies any pain.

(All other Review of System and Physical Exam findings are negative other than stated.)

Vital Signs: BP 165/90, HR 89, RR 20, Temp 98.1

PMH: Hypertension, Hyperlipidemia, Diabetes, Chronic Osteoarthritis

Allergies: Penicillin, lisinopril

Medications:

Women’s One A Day-Multivitamin daily

Chlorthalidone 25mg daily

Fish Oil 1 tablet daily

Amlodipine 5mg p.o. daily

Atorvastatin 40mg p.o. at bedtime daily

Novolog 10 units with meals TID

Aspirin 81mg p.o. daily

Lantus 25 units Subcutaneous nightly

Ergocalciferol 50,000 units PO once a month

Social History: as stated in Case Study

ROS: as stated in Case study

Diagnostics/Assessments done:

• CXR- Last cxr showed no cardiopulmonary findings. Within normal limits.
• Basic Metabolic Panel and CBC as shown below
• Vitamin D Level- as noted below in lab results

TEST	RESULT	REFERENCE RANGE
GLUCOSE	85	65-99
SODIUM	134	135-146
POTASSIUM	4.2	3.5-5.3
CHLORIDE	104	98-110
CARBON DIOXIDE	29	19-30
CALCIUM	9.0	8.6- 10.3
BUN	20	7-25
CREATININE	1.01	0.70-1.25
GLOMERULAR FILTRATION RATE (eGFR)	76	>or=60 mL/min/1.73m2

TEST	RESULT	REFERENCE RANGE
Vitamin D 1,25 OH	58	36-144

TEST	RESULT	REFERENCE RANGE
WBC	7.3	3.4- 10.8
RBC	4.31	135-146
HEMOGLOBIN	14	13-17.2
HEMATOCRIT	42%	36-50
MCV	90	80-100
MCHC	34	32-36
PLATELET	272	150-400