Chapter 24, Problem 5CCS

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.

Explain how the thiazide diuretic might have caused this problem.

When asked about his medications, Mr. Boulard admits that he did not fill his ACE inhibitor prescription because it was too expensive. He could only afford the thiazide medications along with his insulin.