Question

Presentation:

48 yo male complaining of erectile dysfunction. Gained 80 lbs. over the past five years, complains of polydipsia(heavy thirst) and polyuria(frequent urination), smokes 1-2 packs/day, mother and father developed high blood pressure and diabetes in their 50s (type 2). Physical exam is within normal limits except for BMI over 40.

Laboratory profile

Test	Normal or abnormal	Patient Results
Random plasma glucose	Abnormal high	358mg/dl
Sodium	Abnormal low	135 meq/L
Potassium	Abnormal low	3.0 meq/L
Chloride	Abnormal high	110 meq/L
BUN	Abnormal high	21 mg/dl
Creatinine	normal	1.1 mg/dl
WBC	normal	7.5 x 103/ul

1. Which features in this patient’s history are risk factors for diabetes?

2. What symptoms of diabetes are reported by this patient?

3. What is the most likely diagnosis for this patient? How do you know?

4. Does this diagnosis need to be confirmed with additional testing? Why or why not?

5. What two additional laboratory tests might make sense given this patient’s history and current laboratory tests.