nephrology emergency

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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. - PowerPoint PPT Presentation

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  • Nephrology emergencyDr Kok Lai Sun Department of MedicineHospital 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 1What other histories do you want to ask from this patient ?

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

  • On physical examinationHis is tachypnoea with deep sighing breathingAfebrile , BP= 150/94mmHg , PR =100CVS- normalLungs are clear with no abnormalities

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

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

  • Question 5 please interprete this ECG

  • 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!!!

  • Question 6How do you manage his hyperkalemia ?

  • Question 7This is his ABG result . Please interprete.PH= 6.80PaO2= 11 kPa PaCO2= 3.8kPaHCO3= 10BE= -8

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

  • 2nd case20/full time model , NKMIrecurrent syncopal episodes over the past 2 days

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

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

  • On physical examinationblood pressure -125/80 mm Hg, temperature -37.5C, heart rate -90 bpm, regular38kghead, neck, pulmonary, and abdominal examinations are all unremarkablediffuse weakness in all major muscle groups otherwise no other neuro deficit

  • What are the investigations you would do for her ?

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

  • K+ level of 1.6 mmol/Lrest of the electrolytes, notably the magnesium, were within normal limitsNormal thyroid functionpatient 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.

  • How do you manage her hypokalemia ?

  • Thank you !

    *****