Accumulated

A 30-year-old man with an intellectual disability presents with left-sided weakness and dysarthria for two days, in a background of anorexia and nausea for one week.

His medical history is significant for stage IV chronic kidney disease secondary to uncorrected posterior urethral valves. He has been poorly adherent to treatment and is not on any medications right now, including over-the-counter drugs or herbal preparations.

His surgical and family histories are unremarkable. He does not drink, smoke, or use illicit substances. There are no known allergies. He has never been employed. He is a single child and currently lives with his widowed, elderly father.

A complete blood count is only significant for a hemoglobin level of 10.7 mg/dL (normal: 11 - 18). His leukocyte count is 6,500/mm3, with normal differentials.

Select Relevant Investigations
Comprehensive metabolic panel

Performed

Glucose: 145 mg/dL (<200)

Sodium: 141 mEq/L (135 - 145)
Potassium: 4.2 mEq/L (3.6 - 5.2)
Chloride: 101 mEq/L (95 - 105)
Calcium (total): 6.5 mg/dL (8.5 - 10.2)
Phosphorus: 3.4 mg/dL (2.5 - 4.5)

BUN: 56.2 mg/dL (7 - 20)
Creatinine: 3.20 mg/dL (0.7 - 1.3)

ALT: 34 U/L (9 - 51)
AST: 21 U/L (13 - 40)
ALP: 80 U/L (34 - 122)
Bilirubin (total): 0.3 mg/dL (0.1 - 1.1)
Albumin: 4.2 mg/dL (3.5 - 5.5)
Arterial blood gases

Performed

pO2: 90 mmHg (>70)
pCO2: 39 mmHg (35 - 45)
pH: 7.30 (7.35 - 7.45)
HCO3: 22 mmol/l (22 - 26)
saO2: 99%
MRI Brain

Performed

T2-weighted images show bilateral hyperintensities of the periventricular white matter, basal ganglia, and internal capsule, suggestive of cytotoxic edema. There is no evidence of ischemia, hemorrhage, or mass lesions.
Lumbar puncture

Performed

You realize that lumbar puncture is not indicated currently.

Select Relevant Management
Hemodialysis
Calcium supplementation
Sodium Bicarbonate
Anticoagulation