Case Published: November 2021

History of Present Illness (HPI)

A 55-year-old man is brought to the emergency department by his partner because of a 1-day history of altered mental status. The patient has end-stage kidney disease secondary to membranous nephropathy; he is on the kidney transplantation waiting list and has been receiving intermittent hemodialysis for the past 5 years.

His partner reports that the patient’s last dialysis treatment was 3 days ago. The patient has had cramping during dialysis during the past 2 weeks and was prescribed baclofen 20 mg daily and ibuprofen 800 mg as needed. Additional medications include nifedipine, carvedilol, and sevelamer.

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