A 78-year-old female was arrived tired to the emergency roomwith the following symptoms: nausea, vomiting, decreasedrespiration, hypotension, and low pulse rate (46), The skin was notsweaty, it was warm, she is DM, swelling, she take some medicationlike metfromin 850mg, some diuretics, The patient had been treatedfor constipation and heartburn (antacids) within the last 24hours.

Laboratory investigation resulted in the following:

Na+	133 mmol/L	(136-145 mmol/L)
K+	5.3 mmol/L	(3.4-5.0 mmol/L)
CL-	95 mmol/L	(98-107 mmol/L)
Creatinine	2.6 mg/dL	(0.7-1.5 mg/dL)
BUN	40 mg/dL	(5-20 mg/dL)
Magnesium	4.0 mmol/L	(0.63-1.0 mmol/L)
Total protein	5.6 g/dL	(6.0-8.0 g/dL)
Albumin	3.0 g/dL	(3.5-5.0 g/dL)
Calcium	8.4 g/dL	(8.6-10.0 g/dL)
AST	44 U/L	(7-45 U/L)
Fasting blood glucose	162 mg/dL	(75-115 mg/dL)
HbA1c	7.8 %	(4.1-6.8

1. What explanation would you give the doctor for the differencein the electrolytes levels?

2. What is the most likely cause for the hypermagnesemia?

3. Which type of diabetes mellitus should be considered? Andwhy?

type 2 diabetes.

4. What is your explanation for kidney function tests result(high Creatinine and BUN)? Is it indication for pyelonephritis orGFR dysfunction or acute kidney failure? Justify your answer.

5. Does the patient suffer from microalbuminuria regarding toalbumin result? Justify your answer.