The Case

CC

Malaise

HPI

45yo M with obesity, HTN, DM, GERD, EtOH abuse, presents feeling unwell and fatigued. Has mild HA, lightheadedness and for the past few days has been having polyuria with home FS in 300s. Was seen in ED yesterday with elevated FS, but given fluids with improvement in symptoms. Afterward, he saw his endocrinologist who adjusted his medications. Denies fever, abd pain, n/v/d, dysuria.

Physical Exam

BP 156/90, HR 101, RR 17, O2 99%, T 97.5F, FS 121
Gen: NAD, AAOx3
HENT: NCAT, EOMI, PERRL
CV: RRR, 2+ peripheral pulses 
Pulmonary/Chest: CTAB, no resp distress
Abdominal: Soft, NT/ND
Musculoskeletal: FROM, no edema
Neurological: No deficits
Skin: Warm and dry

Labs

CBC: 10 > 15 / 43 < 297, 65% Neut BMP: 138 / 4.8 / 105 / 12 / 15 / 0.6 < 135 VBG: 7.265 / 30 / 32 / 13.7, lactate 3.7 EtOH: <10

Questions

  1. What is your differential for this patient?

  2. What other lab test can confirm your diagnosis?

  3. How would you manage this patient?