A 69 year old female patient was rushed

to the emergency room complaining

dizziness and fatigue.
She was diagnosed with type 2 diabetes 2
years ago. Other medical problems
include obesity and retinonopathy. He
has a history of heavy alcohol use but
quit drinking alcohol 2 years ago. He
presents now for routine follow-up and
is noted to have a blood pressure of
168/100 mmHg.
 Physical exam reveals a
height of 5 feet, 8 inches,
weight of 243 lb, blood
pressure of 160/100 mmHg,
and a regular pulse of 84
beats/min. There is no
clinical evidence of
congestive heart failure.
 The patient is currently taking
the following daily
medications:
Amlodipine
Metformin
In addition, His appetite is
excellent , but she does have
increased frequency of
micturition and urinates 3 to 4
times at night.
FAMILY HISTORY
The patients mother had DM
and died of heart failure at
age 62 years. His father
died when the patient was a
teenager. One male sibling
died at age 69 years from
complications caused by high
blood pressure (BP) and
diabetes.
 CHEMICAL TEST RESULT
SPECIFIC GRAVITY 1.020
Macroscopic examination
PH 7.5
PROTEIN NEGATIVE
Color: Pale yellow
GLUCOSE 2+ Clarity: Cloudy
KETONES NEGATIVE Microscopic Examination
BILIRUBIN NEGATIVE Pus cells: 0-2/hpf
UROBILINOGEN NORMAL
NITRITE NEGATIVE RBC: 1-4/hpf
BLOOD NEGATIVE Epithelial cells: moderate
LEUKOCYTES NEGATIVE
 TEST RESULT REFERENCE RANGE
GLUCOSE 8.98 mmol/L 4.16 - 6.38 mmol/L
HbA1C 7% 4-6 %
POTASSIUM 6.5 3.5-5.2 mmol/L
SODIUM 140 mmol/L 135-145mmol/L
CREATININE 88 umol/L 53-97 umol/min
CHLORIDE 110 mmolL 98-107 mmol/L
BUN 5.0 mmol/L 2.9-8.2 mmol/L
 TEST RESULT REFERENCE RANGE
HEMOGLOBIN 14 g/dL 12-15.5g/dL
HEMATOCRT 42% 38-46%
RBC 5.0x10^6/uL 4.2-5.4 x10^6/uL
WBC 8.5x10^3/uL 4.5-10x10^3/uL
NORMAL DIFF COUNT
PLATELET 254x10^3/uL 150-450 x10^3/uL
MCV 85.0 80-100
MCH 30pg 27-33 pg
MCHC 36.7% 33-36%
 CHEMICAL TEST RESULT Macroscopic examination
SPECIFIC GRAVITY 1.025
Color: Pale yellow
PH 7.5
Clarity: Cloudy
PROTEIN 3+
Microscopic Examination
GLUCOSE 3+
Pus cells: 1-5
KETONES NEGATIVE
BILIRUBIN NEGATIVE RBC: 24-55/hpf
UROBILINOGEN NORMAL Epithelial cells: moderate
NITRITE NEGATIVE RBC Cast-2-3
BLOOD 2+ Granular Cast-5-10
LEUKOCYTES NEGATIVE Broad cast-1-5
Waxy Cast-0-2
 TEST RESULT REFERENCE RANGE
GLUCOSE 10.57 mmol/L 4.16 - 6.38 mmol/L
HbA1C 7% 4-6 %
POTASSIUM 7.5 3.5-5.2 mmol/L
SODIUM 143 mmol/L 135-145mmol/L
CREATININE 298 umol/L 53-97 umol/min
CHLORIDE 189 mmolL 98-107 mmol/L
BUN 9 mmol/L 2.9-8.2 mmol/L
 TEST RESULT REFERENCE RANGE
HEMOGLOBIN 12.5 g/dL 12-15.5g/dL
HEMATOCRT 38% 38-46%
RBC 4.3x10^6/uL 4.2-5.4 x10^6/uL
WBC 8.6x10^3/uL 4.5-10x10^3/uL
NORMAL DIFF COUNT
PLATELET 282x10^3/uL 150-450 x10^3/uL
MCV 80.92 80-100
MCH 29g 27-33 pg
MCHC 33.7% 33-36%