3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M72_F4.jpg"}},{"insert":"\n\nYou try to engage Mrs. Niambi in a conversation, but she quickly drifts off and closes her eyes. You remember that she has stage 3 chronic kidney disease and hypertension. She is currently on furosemide 40mg od, lisinopril 40mg od, and slow-release potassium bd. \n\nOn examination, her temperature is 98.9 \u02daF (37.1 \u02daC). Her pulse is 60 bpm, regular, and strong. Her blood pressure is 115\/75 mmHg when lying down; and 100\/70 mmHg when sitting up. Her respiratory rate is 12\/min. \n\nMrs. Niambi is drowsy but "},{"insert":"arousable","attributes":{"color":"#000000","background":"transparent"}},{"insert":". She is not oriented to place, person or time, and is unable to follow commands. On counting the months of the year backwards she gets to September, but then loses focus and starts talking about something else. Neurological examination is negative for meningism or focal signs. Cardiorespiratory and abdominal examination show no abnormalities.\n\nYou request fingerprick glucose testing and urine dipstick testing. Mrs. Niambi\u0027s capillary glucose is 95 mg\/dL. The urine dipstick test is positive for nitrites and leukocytes.\n"}]}