Week 9: Endocrine, Metabolic, and Nutritional Disorders
Week 9 Case 1: Low Blood Sugar
HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar in the morning, fasting. She reports seeing blood sugar as low as 50 fasting in the mornings for the last few weeks. She has a known history of Diabetes, Hypertension, Hyperlipidemia, and Chronic Osteoarthritis. She also reports elevated blood pressures. Her blood pressure at presentation is 165/90.
RESOURCE FOR THIS WEEK: Review endocrine-related Evidence Based Practice Guidelines.
Ms. Lewis is a 63 y/o female who is AAOX4. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She denies any falls, denies any pain.
(All other Review of System and Physical Exam findings are negative other than stated.)
Vital Signs: BP 165/90, HR 89, RR 20, Temp 98.1
PMH: Hypertension, Hyperlipidemia, Diabetes, Chronic Osteoarthritis
Allergies: Penicillin, lisinopril
Medications:
Women’s One A Day-Multivitamin daily
Chlorthalidone 25mg daily
Fish Oil 1 tablet daily
Amlodipine 5mg p.o. daily
Atorvastatin 40mg p.o. at bedtime daily
Novolog 10 units with meals TID
Aspirin 81mg p.o. daily
Lantus 25 units Subcutaneous nightly
Ergocalciferol 50,000 units PO once a month
Social History: as stated in Case Study
ROS: as stated in Case study
Diagnostics/Assessments done:
- CXR- Last cxr showed no cardiopulmonary findings. Within normal limits.
- Basic Metabolic Panel and CBC as shown below
- Vitamin D Level- as noted below in lab results
| TEST | RESULT | REFERENCE RANGE |
| GLUCOSE | 85 | 65-99 |
| SODIUM | 134 | 135-146 |
| POTASSIUM | 4.2 | 3.5-5.3 |
| CHLORIDE | 104 | 98-110 |
| CARBON DIOXIDE | 29 | 19-30 |
| CALCIUM | 9.0 | 8.6- 10.3 |
| BUN | 20 | 7-25 |
| CREATININE | 1.01 | 0.70-1.25 |
| GLOMERULAR FILTRATION RATE (eGFR) | 76 | >or=60 mL/min/1.73m2 |
| TEST | RESULT | REFERENCE RANGE |
| Vitamin D 1,25 OH | 58 | 36-144 |
| TEST | RESULT | REFERENCE RANGE |
| WBC | 7.3 | 3.4- 10.8 |
| RBC | 4.31 | 135-146 |
| HEMOGLOBIN | 14 | 13-17.2 |
| HEMATOCRIT | 42% | 36-50 |
| MCV | 90 | 80-100 |
| MCHC | 34 | 32-36 |
| PLATELET | 272 | 150-400 |
