Chapter 24, Problem 3CCS

Let’s return to Kyle Boulard, whom we met in the previous chapter. After two days in the hospital, Mr. After two days in the hospital, Kyle Boulard has recovered from his acute diabetic crisis and his type 1 diabetes is once again under control. The last update on his chart before he is discharged includes the following:

BP 150/95, HR 75, temperature $\text{37}\text{.2°C}$

Urine: pH 6.9, negative for glucose and ketones; 24-hour urine collection reveals 170 mg albumin in urine per day

Mr. Boulard is prescribed a thiazide diuretic and an angiotensin converting enzyme (ACE) inhibitor. He is counseled on the importance of keeping his diabetes under control, taking his medications regularly, and keeping his outpatient follow-up appointments.

Where and how do thiazide diuretics act in the kidneys and how does this reduce blood pressure?

At his two-week appointment at the outpatient clinic, Mr. Boulard complains of fatigue, weakness, muscle cramps, and irregular heartbeats. A physical examination and lab tests produce the following observations:

BP 133/90, HR 75

Blood K+ 2.9 mEq/L (normal 3.5–5.5 mEq/L); blood Na+ 135 mEq/L (normal 135–145 mEq/L)

Urine K+ 55 mEq/L (normal <40 mEq/L); urine Na+ 21 mEq/L (normal >20 mEq/L)