Skill Checkup: Woman With Type 2 Diabetes Presents With Dyspnea, Pruritus, and Pitting Edema of Bilateral Extremities

A. Brent Alper, Jr, MD, MPH


March 24, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 53-year-old Black woman presents with shortness of breath, pruritus, and pitting edema of bilateral extremities. She has a 17-year history of type 2 diabetes, hypertension, and hyperlipidemia, and a 35–pack-year history of smoking. Her blood pressure is 165/92 mm Hg, heart rate 94 beats/min (regular rate and rhythm), and respiration 26 breaths/min. She is 5 ft 3 in tall and weighs 202 lb (body mass index = 35.8).

Laboratory tests reveal: hemoglobin 8.7 g/dL; creatinine 2.2 g/dL; estimated glomerular filtration rate (eGFR) 49 mL/min/1.73 m2; serum albumin 3.3 g/dL; A1c 8.8%; low-density lipoprotein 143 mg/dL; high-density lipoprotein 43 mg/dL; random glucose 186 mg/dL; albumin-creatinine ratio 150 mg/g; calcium 8.7 mg/dL; phosphorus 4.2 mg/dL; plasma parathyroid hormone 77 pg/mL. On the basis of these values, the patient is diagnosed with type 2 diabetes that is complicated by chronic kidney disease (CKD).


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