Chapter 25, Problem 3CCS

32-Year-Old Diabetic Male on a Diuretic

Let’s return to Kyle Boulard, whom we met in the previous chapter. Mr. Boulard has recovered from his acute diabetic crisis. The last update on his chart before he is discharged includes the following:

•BP 150/95, HR 75, temperature 37.2°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 taking his medications regularly and keeping his outpatient follow-up appointments.

3. 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, temperature 37.3°C

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⁺ 21mEq/L (normal >20 mEq/L)