W.A. is a 70-year-old woman who presented to the emergency d…
W.A. is a 70-year-old woman who presented to the emergency department with fever, severe nausea, vomiting, and diarrhea. She is admitted to the intensive care unit (ICU) with a diagnosis of kidney failure and septicemia. Her previous medical history includes glaucoma, chronic kidney failure, hypertension, and insulin-dependent diabetes. She had a left above-the-knee amputation 1 year ago. Subjective Data W.A.’s daughter states she was able to do her daily chores at home independently, but for the last few days it was getting difficult for her to get around and that she needed to take frequent breaks because of shortness of breath and no energy. Her daughter reports that W.A. had been having headaches with nausea and dizziness for the past few days. Goes to hemodialysis 3 days a week Objective Data Physical Examination Blood pressure 172/92, pulse 110, temperature 101.5°F, respirations 28 Oxygen saturation 86% on 15 LPM via mask Oriented to name only Crackles in bilateral lower lobes 2+ edema bilateral lower extremities and hands Abdomen is distended with hypoactive bowel sounds x4 quadrants Diagnostic Studies CBC: Hemoglobin 7 g/dL (12-16 G/dL), hematocrit 23.8% (36-48%), RBC 2.57 m/mm3 (4.7-6.1 m/mm3), WBC 14.8 mm3 (4.5-11 mm3), Chemistry Panel: Serum sodium 132 mEq/L (135-145 mEq/L), serum potassium 6.0 mEq/L (3.5-5.2 mEq/L), calcium 9.3 mg/dL (8.5-9.2 mg/dl), phosphorus 6.0 mg/dL (2.8-4.5 mg/dl), glucose 197 mg/dL (70-100 mg/dl), albumin 2.4 G/dl 3.5-4.4 G/dl), serum blood urea nitrogen 77 mg/dL (5-20 mg/dL), serum creatinine 7.30 mg/dL (0.6-1.1 mg/dL), eGFR African American 10 (>60), BNP 182 pg/mL (