[NP-Clinical] 2 lab cases

[Priscilla Merrill]

Thanks for all the replies on the 2nd case.  I'll consider all this.  I was
surprised his HGAIC was so good because he's very non-compliant.  Single
young guy, awful fatty prepared diet and he is not motivated to change.
Back to ethnicity and which drugs, I think I'll try a concomitant norvasc as
the author replier suggested.  Low and slow as his BP is good.
Priscilla

-----Original Message-----
From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Sue Wiers
Sent: Monday, February 12, 2007 7:38 AM
To: np-clinical at nurse.net
Subject: RE: [NP-Clinical] 2 lab cases

Priscilla,

I am absolutely NOT an endocrine/diabetes expert.  Just a few thoughts based

on a few anecdotal experiences of my own.  First, the CPK is a bit up, but 
not nearly as high as the one that I have seen related to statin use.  I'd 
recheck and see if it comes down (not to suggest that you should disregard 
what people before me have mentioned in case something serious is brewing).

I had a guy whose CPK was elevated from bouncing around on a jet ski - lots 
of things can cause it!

As you said, definitely need a creatinine.  I'd also do a urine dip in the 
office.  I don't know at what point you would call it macroalbuminuria, 
seems like this # would show up on a dip.  If blood is also on the dip, 
something else to look for to explain the proteinuria (then of course, a 
whole new work-up is required).  I imagine the Thai patient is thin?  I have

a few healthy, but obese patients with proteinuria on dip, and the 24 hour 
urines and serum BUN and creatinine are fine.   The diabetic patient whom I 
have who is currently on a kidney transplant list had plenty of other things

to support the diagnosis of renal insufficiency - anemia, elevated 
creatinine, long-term ignored, uncontrolled DM.

Sue Wiers FNP

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