Marianna M. is a 61-year-old female who is in the clinic for a check-up. Her last examination was 5 years ago. She has no complaint other than leg numbness and tingling from time to time. She also reports feeling thirsty and tired.

What major problems can you identify for this patient? What subjective and objective information in the case supports each of those problems? What is your assessment and plan for each problem? What medications and doses are appropriate for this patient? Differential diagnosis?

Social history: no smoking or alcohol consumption.

Physical examination:

GEN: well nourished, slightly obese female.

VS: BP 180/103 HR 73 RR 13 T 98.4 Wt 90 kg, HT 5’6”

HEENT: PERRLA

COR: RRR, NMRG

CHEST: CTA

NEURO: monofilament test shows decreased peripheral sensation

EXT: normal

Laboratory (fasting):

Na 139

K 3.8

ALT 34

Ca 9.1

CL 102

HCO3 22

AST 39

TP 6

BUN 33

SCr 1.8

Alb 4.1

Cholesterol 254

BG 275

UA: SG 1.013, pH 6.5, +++ protein