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Originally published: Common Sense September/October 2019
A 77-year-old patient comes into the ED for a complaint of shortness of breath x 6 months. This is the first time the patient has come to this hospital and there are no medical records in the EHR. The patient doesn’t remember what problems they have, but they know they’re on some sort of medication for their heart. They deny any kidney problems. You optimize the patient in the ED, see no acute ECG changes, no troponin elevations, but a creatinine of 2.3 and a BNP that is mildly elevated. You admit for heart failure and AKI. Multiple renal and cardiac studies are done in house because his records can’t be retrieved. Once they are retrieved you see that his BNP and Cr are within baseline and the patient did not require admission.