Exchange
Renal & Urinary System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M6_F1.jpg"}},{"insert":"\n\n"},{"insert":"You are relaxing in your office, playing a game on your tablet.\n\nWhile smashing alien lifepods with your laser, you realise that for the first time in many weeks, you\u0027ve actually had a decent day, without the stress of dealing with life-or-death situations.\n\nJust as you are about to level up, a nurse announces the arrival of a new patient.\n\nThe words \u0022good things never last\u0022 pop into your mind as you place your tablet on the table and head out ...\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M6_F2.jpg"}},{"insert":"\n\n"},{"insert":"You are introduced to Mr. Sato, a 76 year old retired engineer.\n\nSince waking up today, he has been mildly dyspneic; this has gradually worsened over the last several hours.\n\nHe was diagnosed with hypertension and chronic kidney disease (CKD) of unknown etiology 12 years ago, and is currently in CKD stage IV.\n\nHis last visit to the renal clinic was just one week ago.\n\nAt that time, his blood pressure was stable at 130\/80 mmHg, while his serum creatinine was 4.0 mg\/dL, giving an estimated glomerular filtration rate (eGFR) of 14 ml\/min\/1.73 m2.\n\nHe has not required dialysis so far, and there is no history of cardiac disease.\n\nOn examination, his pulse is 80 bpm, blood pressure is 160\/70 mmHg, and respiratory rate is 24\/min. There is no peripheral edema.\n\nHe is markedly dyspneic, and using the accessory muscles of respiration. Auscultation reveals fine crackles over both lung fields.\n\nThe remainder of the examination is unremarkable.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M6_F3.jpg"}},{"insert":"\n\n"},{"insert":"Serial ECGs are found to be normal, but a chest X-ray shows features suggestive of pulmonary edema.\n\nA renal function and electrolyte assay reveals the following:\n\nSodium: 143 mEq\/L (135 - 153)\nPotassium: 5.9 mEq\/L (3.5 - 5.3)\nBlood urea: 120 mg\/dL (5 - 26)\nSerum creatinine: 11.0 mg\/dL (0.5 - 1.5)\nAlbumin: 3.7 g\/dL (3.4 - 5.4)\n\nA full blood count is as follows:\n\nWBC: 12,000\/mm3 (4,000 - 11,000)\nHb: 11.8 g\/dL (13.0 - 18.0)\nHematocrit (PCV): 35% (36 - 44)\nPlatelets: 167,000\/mm3 (150,000 - 400,000)\n\nUrinalysis reveals protein of 30 mg\/dL, with 20 to 30 red blood cells per high-power field.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M6_F2.jpg"}},{"insert":"\n\n"},{"insert":"You decide that the best option at this point is to start Mr. Sato on dialysis.\n\nHowever, he emphatically refuses this, despite your best efforts to convince him otherwise.\n"}]}
4
{"ops":[{"insert":"What do you do now?\n"}]}
1. Admit Mr Sato to the intensive care unit and start IV Furosemide
2. Noninvasive Pressure Support Ventilation (NPSV)
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