Dr Kok Lai Sun Department of Medicine Hospital Pulau Pinang 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 = 6.80 PaO2 = 11 kPa PaCO2 = 3.8kPa HCO3 = 10 BE = -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 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 !