Dr. Ajeet Singh (Family Medicine) needs a second opinion on this medical case.
A 62 year old male patient who has been on treatment for T2DM with HTN from April 2020.
In the last 20 days,he has been having pain in joints, different different joints, so he had been taking analgesics from so many doctors.
Never underwent any test so far in the past months since April, but today came to clinic with alarming reports.
His BP always fluctuated between 170 to 190 systolic and Diastolic between 90 to 110 mmHg, similarly sugars fluctuated too. But recently his sugars and BP were under control.
Furthermore, he often stops his medicines at his own will.
He was currently on following medicines -
Tab. Amlodipine 5mg + HCTZ 12.5 + Telmisartan 40mg OD
Tab. Spironolactone 25mg OD
Tab. Glimipiride 2mg + Metformin 1000mg twice daily,
Tab. Remogliflozin 100mg BD,
He was on Empagliflozin 25 + Linagliptin 5mg before, but due to cost shifted on Remogliflozin
With an eGFR of 20ml/min/1.73m2 by MDRD Equation, Uric Acid 8.7 and potassium reaching upper limit to 5.3, I have stopped Telmisartan,Hydrochlorthiazide, Metformin and Spironolactone
My concerns are -
1) I have added him febuxostat 80mg at bedtime. Ur advice?
2) I have stopped his Telmisartan, HCTZ, and shifted him to amlodipine 5mg once daily? What other anti hypertensives would be best for him?
3) I have stopped metformin and started him again on combination of Empagliflozin + Linagliptin 25/5mg once daily in morning, along with Glimipiride 2mg BD. Is Glimipiride a better choice or Gliclazide?
5) How to counteract his hyperphosphatemia state? Calcium supplements or Vitamin D3 supplements?
6) Frequency like in how many days to repeat KFT?