Biblioteca Central EsSalud

A 53-year-old man presented to the emergency department of this hospital because of leg weakness, pain, and weight loss.
Five months before the current presentation, the patient began to have profound thirst, frequent urination, and fatigue. He established care with a local primary care clinic for evaluation of these symptoms. At that time, the patient also reported atraumatic pain in the left hip that radiated to the thigh. The pain was most prominent when he ascended stairs. He had had an 11-kg weight loss during the preceding year, which he had ascribed to a poor appetite. A physical examination, including neurologic examination, was reportedly normal. The glycated hemoglobin level was greater than 14.0% (reference range, 4.3 to 5.6). Results of additional laboratory testing, including blood levels of electrolytes, aspartate aminotransferase, alanine aminotransferase, albumin, and bilirubin, along with results of kidney-function tests and a complete blood count, were normal. Treatment with metformin and dulaglutide was initiated.