HTN w/ CKD vs DM w/ CKD Which is my PDx

bbuckmasterbbuckmaster
in Clinical & Coding

I am reviewing a patient's chart who presented to the ER with a Jxnal escape rhythm.  The patient has hyperK+, Chronic Kidney Disease, DM and HTN.  The MD connects the Jxnal escape rhythm to the hyperK+ 2/2 the AKI and progression of CKD.  The MD also connects the CKD to the DM in his active problem list.  There are no other inciting events to the AKI.  The patient comes in with BG 202 and is on SQ Insulin chronically.  The patient also has multiple PO HTN Meds.

What should be my PDx?

Comments

  • Amy_Stremming_1992Amy_Stremming_1992
    Good question! I would go with AKI since the junctional escape rhythm was due to the hyperK which was 2/2 AKI. The junctional escape rhythm was a symptom of the AKI which was the true acute problem necessitating admission---getting the AKI under control will fix the hyperK plus the arrhythmia . It will be interesting to see what others would choose.
  • bbogda@morrishospital.orgbbogda@morrishospital.org
    Agree with Amy.
  • stayrookgt@gmail.comstayrookgt@gmail.com
    I am also very confused about the new guideline and the causal relationship between htn and chf.  I thought that usually diastolic chf was caused by hypertension.  I also looked at echo's for LVH before sending a query.  Now if the patient has acute systolic heart failure and hypertension, there is a link between hypertension and the heart failure and the CKD? I didn't think that systolic heart failure usually comes from hypertension?
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