[NP-Clinical] 2 lab cases

[Amelie Hollier]

Hi Priscilla-

I’m not a diabetic guru, but, some thoughts about patient #2, the Thai
diabetic with microalbuminuria.

 

First, consider that maybe there is some non-diabetic renal disease going on
too. If this is part of his problem, a different drug approach may benefit
him. I remember reading that up to 1/3 of diabetics have this in conjunction
with the diabetic kidney changes. There’s an interesting article below: 

 

HYPERLINK
"http://jasn.asnjournals.org/cgi/content/full/16/3_suppl_1/S64"http://jasn.a
snjournals.org/cgi/content/full/16/3_suppl_1/S64

 

Second, non-DHP calcium channel blockers have been shown to decrease
proteinuria, especially when used in combination with an ACE in diabetics.
The DHPs may actually increase proteinuria, so, I’d avoid these.

 

Which ACE is he taking?

 

Amelie

 

Amelie Hollier, MSN, RN, BC

President, APEA

Nurse Practitioner

HYPERLINK "http://www.apea.com"www.apea.com

Lafayette, LA

HYPERLINK "mailto:amelie at apea.com"amelie at apea.com

   _____  

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Priscilla Merrill
Sent: Saturday, February 10, 2007 2:04 PM
To: 'NP Clinical'
Subject: [NP-Clinical] 2 lab cases

 

Pt #1.  Just inherited her.  Very symptomatic, fatigued, logy.  TSH was
about 8 last Fall,  then 5.5 2 mos ago.  These are the results I got.  The
others have only been TSH in past.  She has gone from 25 mcg synthroid
(generic levothyroxine) to 75 mg over 3 6 week increments.  I’m assuming
next step is to increase by 25 mcg again but anything else based ont the
high antibodies?  Thanks to your thyroid gurus out there!

Thanks to Logician home access, I could copy and paste.  Yee Haw!!!

Tests: (1) TSH (30163E)

  TSH                       1.0 uIU/mL                  0.3-5.5          *1

Tests: (2) Free Thyroxine (30247W)

  Free Thyroxine            1.6 ng/dL                   0.8-1.8          *2

Tests: (3) Thyroid Peroxidase Antibodies (80994R)

! Thyroid Peroxidase Antibodies

                       [H]  >1000 IU/mL                 0-34             *3

Pt #2:  DM 2 Thai young man, about 30’s.  Already on ACE, HCTZ, ASA and
Lipitor.  What would you DM gurus recommend with this high microalb.  BP is
well controlled.  ARB????  Not sure why the CK is up.  I think it was
ordered (these were by another provider but she has left) for vague
myalgias.

Lately I’ve had a few well-controlled diabetics on the standard meds with
high microalb ratios and not sure what’s recommended after ACE.

I need to check creatinine’s next time but they have all been fine in the
past.  These are all folks under 50 by the way and we have a large SE Asian
population.

Thanks for advice!!  Priscilla

Tests: (1) Electrolyte Panel (315F)

  Sodium                    139 mmol/L                  135-146          *1

  Potassium                 4.4 mmol/L                  3.5-5.3          *2

  Chloride                  102 mmol/L                  98-110           *3

  CO2                       26 mmol/L                   21-33            *4

Tests: (2) Glycohemoglobin (45484R)

  Hemoglobin A1c       [H]  6.0 %                       0.0-5.9          *5

                             Well-controlled or

                             Non-diabetic: < 6.0%

                             Diabetic hemoglobin A1c:

                              therapeutic goal: < 7%

                              re-evaluate therapy: > 8%

 Calculated Mean Glucose

                            136 mg/dL                                    *6

Tests: (3) Microalbumin (random urine) (6517X)

 Creatinine Random (Urine)

                            227 mg/dL                   20-370           *7

  Microalbumin (urine) [H]  1910 ug/mL                  0-29             *8

 Microalbumin/Creatinine Ratio

                       [H]  841 ug/mg Creatinine        0-29             *9

Tests: (4) BUN (30940E)

  BUN                       10 mg/dL                    7-25             *10

Tests: (5) CK (21576R)

  CK                   [H]  272 IU/L                    0-200            *11

 

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