Renal Evaluation
During the hospitalization, an ultrasound showed bilateral
11-centimeter kidneys. There was no improvement in her BUN and
creatinine levels but her hyperkalemia diminished with Kayexalate.
Procardia was continued for her hypertension. A renal biopsy was
not done because the nephrologist felt that she had an exacerbation
of a chronic diabetic nephropathy.
Post-Hospitalization Course
After discharge, she returned to her primary care physician who
obtained the additional history that she had been seeing a
curandero (lay healer) for some time. The curandero had indicated
that because her diabetes was due to "an internal pathogen," she
needed to "purge her system." To that end, he recommended the
intake of one cup of aloe vera juice every morning. She had
complied faithfully with this regimen with resultant vomiting and
diarrhea for quite some time. Unfortunately, what she thought to
be aloe vera juice turned out to be aloe vera hand lotion. Among
other constituents, it contained propylene glycol.
The patient continued to have renal insufficiency and hyperkalemia
as an outpatient. Vascular access was initiated and she is now on
chronic hemodialysis. She is followed by a nephrologist, rather
than a primary care physician.
Assignment:
All students:
-
List at least four "lessons learned" from this case with regard
to the role of folk medical beliefs and practices in the workup of
patients with Hispanic cultural ties.
- Compare your list with the comments
provided by the clinician who contributed the case.