Uremic Encephalopathy Secondary to Medical Noncompliance

​BY GREGORY TAYLOR, DO, &CHRISTOPHER COOLEY, DOA 66-year-old woman with a history of type 1 diabetes, hypertension, and end-stage renal disease (ESRD) on hemodialysis presented via EMS to the emergency department with altered mental status. She lived with her family, and they noted that she refused to go to dialysis for her past four sessions and had increasing lethargy for two days.She was afebrile, and her other vital signs were blood pressure 136/92 mmHg, heart rate 77 bpm, respiratory rate 20 bpm, and oxygen saturation 96% on room air. She was agitated and reaching for objects in the sky. Her cardiopulmonary exam was notable for a regular rate and rhythm with coarse breath sounds bilaterally, and she was alert and oriented x 1 (baseline of AOx3). Her speech was slurred, and her exam was limited due to little patient cooperation and altered mental status.She was also experiencing asterixis to her arms, and she had 2+ pitting edema bilaterally to her legs, extending to distal knees. An ECG revealed a normal sinus rhythm of 82 and peaked T-waves, with a prolonged PR interval and QT interval concerning for hyperkalemia.Chest radiography revealed bilateral pulmonary vascular congestion and bilateral pleural effusions. (Images A and B.) A CT of the head without IV contrast was negative for any acute process. Pertinent laboratory evaluation was notable for a white blood cell count of 11.2, hemoglobin of 6.8 g/dL, hematocrit of 21.3, and a platelet level of 370. Basic metab...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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Source: Journal of Genetics and Genomics - Category: Genetics & Stem Cells Source Type: research
This article describes details of each stage of the mission and includes a discussion of key aspects of logistics and patient care posed by such evacuations. PMID: 31977424 [PubMed - in process]
Source: The American Journal of Nursing - Category: Nursing Authors: Tags: Am J Nurs Source Type: research
PMID: 31977420 [PubMed - in process]
Source: The American Journal of Nursing - Category: Nursing Authors: Tags: Am J Nurs Source Type: research
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Source: The American Journal of Nursing - Category: Nursing Authors: Tags: Am J Nurs Source Type: research
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Source: The American Journal of Nursing - Category: Nursing Authors: Tags: Am J Nurs Source Type: research
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Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
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Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Emergency Medicine Source Type: forums
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Source: Journal of Gerontological Nursing - Category: Nursing Authors: Tags: J Gerontol Nurs Source Type: research
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Source: Progress in Retinal and Eye Research - Category: Opthalmology Source Type: research
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Source: Journal of Functional Foods - Category: Nutrition Source Type: research
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