A 56-year-old man with a 10-year history of type 2 diabetes and hypertension presents to the emergency department with progressive nausea, malaise, and dyspnea over 2 days. He denies chest pain, fever, or recent infections. Vital signs show BP 168/98 mmHg, HR 102/min, RR 24/min. Laboratory studies reveal: Serum creatinine: 4.8 mg/dL (baseline 1.0 mg/dL 3 months ago) BUN: 68 mg/dL Serum glucose: 156 mg/dL Serum pH: 7.18 HCO3−: 13 mEq/L Anion gap: 18 mEq/L Serum ketones: Negative Urinalysis: No ketones, muddy brown casts, proteinuria Arterial blood gas shows metabolic acidosis with appropriate respiratory compensation Which of the following is the most likely diagnosis?
- A)Diabetic ketoacidosis with concurrent acute kidney injury
- B)Hyperglycemic hyperosmolar state complicated by sepsis
- C)Uremic metabolic acidosis due to acute kidney injuryGABARITO
- D)Lactic acidosis secondary to cardiogenic shock
- E)Mixed metabolic acidosis from concurrent diabetic ketoacidosis and uremia
Explicação
The clinical presentation is consistent with uremic metabolic acidosis from acute kidney injury. Key findings supporting this diagnosis include: (1) acute elevation of creatinine and BUN with muddy brown casts suggesting intrinsic renal disease; (2) high anion... Ver explicação completa e trilha adaptativa →