Uremic encephalopathy Quiz: Ace Your Exams
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A 63-year-old man presents to the emergency department for evaluation of progressive confusion over the past week. The patient was brought in by family members who state that the patient has been hospitalized for similar issues five times in the past two months despite strict adherence with his dialysis schedule. Past medical history includes hypertension, diabetes, hyperlipidemia, and chronic kidney disease on dialysis. Temperature is 37.2°C (99°F), blood pressure is 178/85 mmHg, pulse is 101/min, respiratory rate is 17/min, and O2 saturation is 95% on room air. Physical examination reveals a confused patient. He is moving all extremities spontaneously. A thrill is palpable over a right upper extremity fistula. Pulmonary exam reveals rales at the bilateral bases. Initial laboratory findings are detailed below. ECG demonstrates normal sinus rhythm and peaked T waves. Nephrology is consulted, and the patient receives emergent dialysis. Which of the following is the best next step in management?
| Laboratory value | Result |
| Serum chemistry | |
| Sodium | 139 mEq/L |
| Potassium | 5.7 mEq/L |
| Chloride | 96 mEq/L |
| Creatinine | 13.2 mg/dL |
| HCO3 | 26 mEq/L |
| Glucose | 176 mg/dL |
| BUN | 106 |
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