Case Study (Biochemical Assessment)

James D. is referred to your outpatient clinic following a recent admit for complications related to his DM type 2. James is a 38 YOWM, 5’9” 210# with a L BKA. He has had multiple admissions to the hospital due to PVD, peripheral neuropathy and dehydration. His most recent admission was for treatment of a non-healing ankle wound that began as a blister and has progressed into a stage 3-pressure ulcer. His foot is cyanotic and the admission was for the purpose of debridement. The physician is quite concerned due to the advanced level of complications in such a young patient. She has referred the patient to your clinic for aggressive outpatient intervention and education.

Lab values :

Albumin: 2.2 mg/dl

Prealbumin 8.9 mg/dl

BUN 52 mg/dl

Creatinine 3.1 mg/dl

Anion gap 12

H/H 10.8/32

Fasting Blood glucose: 210 mg/dl

K+ 4.2 mg/dl

Na + 136

Osmolality 289 mMol/dl

24 hour recall :

2 scrambled eggs

3 slices bacon

2 slices toast with butter

2 tsp jelly

8 ounces orange juice

1 cup whole milk

Large cheeseburger (Mcdonald’s or Burger King)

Large fries

2-3 pkgs ketchup

apple pie

24 ounce coke

4 slices deep dish pepperoni pizza

3-12 ounce beers

6 oreo cookies