A 34-year-old woman has had insulin-dependent diabetes mellitus for 23 years. She has developed a nu. Question
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A 34-year-old woman has had insulin-dependent diabetes mellitus for 23 years. She has developed a number of diabetic microvascular complications including retinopathy, peripheral neuropathy, and nephropathy. Proteinuria was first noted 7 years ago when a dipstick for protein was positive on a routine urinalysis. Since that time, protein excretion has progressively increased to 5.6 g/day and her plasma creatinine concentration has risen from 1.0 to 7.3 mg/dL. She now complains of increasing fatigue but her appetite remains good. Her medications include insulin, a diuretic, and an angiotensin-converting enzyme inhibitor for hypertension, and calcium carbonate as a phosphate binder. Physical examination reveals a well-appearing, slightly pale woman in no acute distress. Positive findings include a blood pressure of 150/90, decreased visual acuity bilaterally with evidence of microaneurysms and exudates on fundoscopic examination, 2+(moderate ) peripheral edema extending up to the mid-calf, and decreased vibration sense, and deep tendon reflexes. Laboratory data reveal the following: BUN =85 mg/dL (9-25) Creatinine =7.3 mg/dL (0.8-1.4) Sodium. =140 mEq/L (136-142) Potassium. =5.7 mEq/L (3.5-5) Chloride. =106 mEq/L (98-108) Total CO2 =15 mEq/L (21-30) Calcium =9.6mg/dL (9-10.4) Phosphate =5.8 mg/dL (3.0-4.5) Hemoglobin =9g/dL (13-15) Questions 1. What is the most likely diagnosis for this patient? What were the evidences for the diagnosis? Which stage may this patient present with? 2. What are the hormonal responses to hypophosphatemia that increase the plasma phosphate concentration toward normal without producing any significant change in the plasma calcium concentration?
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A 34-year-old woman has had insulin-dependent diabetes mellitus for 23 years. She has developed a nu
