September 16, 2010

Sudden Onset Shortness of Breath in Patient with Chronic Renal Failure

45 Years old Malay man was brought to casualty through ambulance call after developing sudden onset shortness of breath and chest pain after two hours on femoral vein dialysis. Below are the result of his investigation.

Vital sign
BP: 134/90
PR: 140
RR: 30
T: 38°C

Chest X ray (Mobile), AP view

Sinus tachycardia
No ischemic changes

Renal Function Test
Urea : 29.4 mmol/l
Natrium : 131.7 mmol/l
Pottasium : 5.2 mmol/l
Chloride : 92.4 mmol/l
Creatinine : 1389.9 µmol/l
uric acid : 635 µmol/l
CKMB : 20 U/l

Full Blood Count
WBC : 30.98 X103 (predominant neutrophil)
HGB : 8.5 g/dL
HCT : 28.8
Plt : 722

ABG under High flow mask 15L/min
pH : 7.04
pCO2 : 35 mmHg
pO2 : 66mmHg
HCO3-: 9 mmol/L

1) Outline the physiology function of kidney
2) Comment on the result of investigation
3) What is your provisional diagnosis
4) Outline your management to this patient.

for answer and discussion click [here]

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