Case 31: Introduction

History of Present Illness (HPI)

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A 55 year old woman with end stage kidney disease (ESKD) due to diabetic nephropathy who receives in-center hemodialysis 3 times weekly (Monday, Wednesday, Friday), is brought to the emergency room on a Saturday morning with shortness of breath. She lives in a different city and is visiting her daughter for the weekend. She tells you she received dialysis yesterday evening, but soon becomes lethargic, hypoxic, and hypotensive requiring emergent intubation and a transfer to the intensive care unit.

The daughter who is present confirms that the patient does not make urine. You notice that she has a right femoral tunneled dialysis catheter. Unfortunately, you do not have information about her history of vascular accesses.

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