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Nephrology emergency

Nephrology emergency. Dr Kok Lai Sun Department of Medicine Hospital Pulau Pinang. At casualty. 56 / male/ taxi driver With diabetic nephropathy with baseline creatinine 300umol/L Presented to casualty with palpitation for 1 day. Question 1.

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Nephrology emergency

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  1. Nephrology emergency Dr Kok Lai Sun Department of Medicine Hospital Pulau Pinang

  2. At casualty • 56 / male/ taxi driver • With diabetic nephropathy with baseline creatinine 300umol/L • Presented to casualty with palpitation for 1 day

  3. Question 1 • What other histories do you want to ask from this patient ?

  4. Question 2 • He was just started on perindopril 4mg od 2 weeks ago . What are the potential adverse effects of this medication?

  5. On physical examination • His is tachypnoea with deep sighing breathing • Afebrile , BP= 150/94mmHg , PR =100 • CVS- normal • Lungs are clear with no abnormalities

  6. Question 3 • What other clinical examination would you do for this patient ?

  7. Question 4 • What are the investigations you would do for him ?

  8. Question 5 please interprete this ECG

  9. His potassium level was 7 mmol/L • It is very important to identify this in order to save the patient because lab results come back much later!!!

  10. Question 6 • How do you manage his hyperkalemia ?

  11. Question 7 • This is his ABG result . Please interprete. • PH = 6.80 • PaO2 = 11 kPa • PaCO2 = 3.8kPa • HCO3 = 10 • BE = -8

  12. Question 7 • What are the causes for his ABG abnormality? • How to manage this ?

  13. 2nd case • 20/full time model , NKMI • recurrent syncopal episodes over the past 2 days

  14. Question 1 • What other histories do you want to ask from this patient ?

  15. the patient reports increased weakness and weight loss over the past 3 months.

  16. On physical examination • blood pressure -125/80 mm Hg, temperature -37.5°C, heart rate -90 bpm, regular • 38kg • head, neck, pulmonary, and abdominal examinations are all unremarkable • diffuse weakness in all major muscle groups otherwise no other neuro deficit

  17. What are the investigations you would do for her ?

  18. While waiting other investigations, your nurse show you this. please interprete this ECG

  19. K+ level of 1.6 mmol/L • rest of the electrolytes, notably the magnesium, were within normal limits • Normal thyroid function • patient was questioned further and admitted to a long history of self-induced vomiting to help reduce her weight, with a recent increase in frequency over the last several months.

  20. How do you manage her hypokalemia ?

  21. Thank you !

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