F.F., a 58-year-old man with type 2 diabetes mellitus, comes to the emergency department with severe right
flank and abdominal pain and nausea and vomiting. The abdomen is soft and without tenderness.
The
right flank is extremely tender to the touch and to palpation. Vital signs are 142/80, 88, 20, 99° F (37.2° C).
Urinalysis shows hematuria. An IV of 0.9% normal saline is started at 125 mL/hr. An IV pyelogram (IVP)
confirms the diagnosis of a staghorn-type stone in the right renal pelvis. The right kidney looks enlarged.
F.F. states that he did not sleep well last night and has not eaten much today. He is obviously fatigued. His
laboratory results are listed in the chart. F.F. weighs 277 pounds.
Review F.F.'s lab work, and note any value that might be of concern.
Overall, the results are within normal limits except for the creatinine, BUN, and glucose levels. The
elevated creatinine and BUN might reflect renal damage or dehydration (from the nausea and
vomiting). The elevated glucose is obviously related to F.F.'s history of DM, but stress will also cause
the levels to rise. It is necessary to note, too, that the glucose level is elevated, despite his nausea
and vomiting and assumed low PO intake. The cholesterol level is at the top of the normal range, but
addressing it at this time might not be a priority.
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