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Original Question

Mr Fowler it’s a 7 year old male who is sent to the Ed by his primary care physician for further evaluation of a grinding of 3.2 mg/dL following a three day history of nausea and vomiting now with dry hives, poor PO intake, fatigue, the crazy rain volume and orthostatic hypotension (108/60) and tachycardia (98 bmp). PMH it’s significant for lifting a heavy object resulting in a low back pain one week prior. He self-medicated with NSAIDS (Naproxen) BID). his medications include lisinopril, metoprolol, and HCTZ. His PMH is also significant for mild chronic renal disease with a creatinine (one month ago) of 1.1 with 400 mg albuminuria. Physical exam is notable for dry mucous membranes, mild periumbilical tenderness and lack of CVA tenderness or bladder distention. Diagnosis will be medication related uremia can you give me a plan 1)Additional labs or diiagnostic test 2)consults 3)Therapeutic modalites 4)health promotion 5)Disposition/follow-up instructions

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