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
• What 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 examination
His is tachypnoea with deep sighing
breathing
Afebrile , BP= 150/94mmHg , PR =100
CVS- normal
Lungs are clear with no abnormalities
Question 3
What other clinical examination would you
do for this patient ?
Question 4
What 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 6
How do you manage his hyperkalemia ?
Question 7
This is his ABG result . Please interprete.
– PH
– PaO2
– PaCO2
– HCO3
– BE
= 6.80
= 11 kPa
= 3.8kPa
= 10
= -8
Question 7
What are the causes for his ABG
abnormality?
How to manage this ?
2nd case
20/full time model , NKMI
recurrent syncopal episodes over the past
2 days
Question 1
What 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 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
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/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.
How do you manage her hypokalemia ?
Thank you !