Nephrology emergency

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

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Question 3

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

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Question 4

• What are the investigations you would do for him
  ?

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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!!!

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Question 6

• How do you manage his hyperkalemia ?

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Question 7

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

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Question 7

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

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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
  -37.5C, 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
  ?

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

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• How do you manage her hypokalemia ?

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Thank you !