A 45-year-old female patient complains of nausea, vomiting, fatigue, and weakness. She admits to a history of heroin abuse for 11 years. She quit using the drug after rehabilitation last year and denies current use of the drug
Habits include use of alcohol daily, 4-5 "drinks a day," and tobacco use of 60-pack years. On physical examination, she is non-febrile, has a blood pressure of 148/98, pulse 78, and resps 16/min. The patient has periorbital edema. Lungs are clear to auscultation. Abdomen is non-tender and distended w/ mild hepatomegaly. No neurologic deficits. Laboratory testing reveals Hgb 10, BUN of 60, potassium 6.1, and serum creatinine 2.9 mg/dL. These findings are characteristic of:
A. Chronic renal failure
B. Dehydration
C. Congestive heart failure
D. Liver failure
ANS: A
Patients with mild renal dysfunction are generally asymptomatic, but as the disease progresses, vague symptoms appear. Fatigue and weakness are early signs, as are decreased cognitive functioning and irritability. Patients may complain of nocturia, which is due to the kidney not concentrating the urine at night. Many of these early signs are nonspecific, and patients often pass them off as a normal part of aging. GI complaints, such as nausea, vomiting, and anorexia, are common and contribute to the muscle wasting and fatigue. Patients may complain of a metallic taste in the mouth. Hypertension may develop from fluid overload and can result in CHF. Pericarditis may develop, producing a friction rub. Neurological symptoms include muscle cramps and twitching, peripheral neuropathy, difficulty concentrating, and sleep disturbances.
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