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