Uremic encephalopathy Quiz: Ace Your Exams
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A 57-year-old man is brought to the emergency department by his partner for evaluation of progressive confusion. The patient has recently missed multiple dialysis sessions due to a non-functioning hemodialysis catheter. Past medical history is significant for hypertension, diabetes, hyperlipidemia, and chronic kidney disease. Temperature is 37.2°C (99°F), blood pressure is 177/95 mmHg, pulse is 98/min, respiratory rate is 18/min, and O2 saturation is 95% on room air. BMI is 38 kg/m2. The patient is on a stretcher moaning but not speaking clearly. He is moving all extremities spontaneously with no focal neurological deficits. Pulmonary exam reveals bilateral rales. Initial laboratory findings are detailed below. ECG demonstrates normal sinus rhythm and peaked T waves. Which of the following is the best next step in management?
| Laboratory value | Result |
| Serum chemistry | |
| Sodium | 141 mEq/L |
| Potassium | 5.7 mEq/L |
| Chloride | 97 mEq/L |
| Creatinine | 12.2 mg/dL |
| HCO3 | 30 mEq/L |
| Glucose | 157 mg/dL |
| BUN | 97 |
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