Clinical Presentation & Protocol
Patient Usually Complains Of
Patient with long-standing hypertension and diabetes presents with progressively worsening fatigue, nausea, generalized pruritus, and bilateral leg swelling. Reports a metallic taste in the mouth and decreased urine output.
Clinical Examination Findings
Sallow, uremic complexion. Noticeable generalized excoriations from severe pruritus. Uremic fetor (ammonia-like breath odor) is present.
Treatment Protocol
Urgent Nephrology referral for hemodialysis access planning (AV Fistula creation). Adjust all renally cleared medications. Start loop diuretics for volume management and sevelamer for hyperphosphatemia. Order stat renal panel and PTH.