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velavela 13 May 2012 05:26
in discussion Hidden / Per page discussions » Ward Rounds 1

I agree with Chee Yoong except for one thing - A blood urea above 7mmol/L is an indication for dialysis? This does not seem right.

I think high blood urea and high serum creatinine only suggest that a dialysis may become necessary sooner or later. If a patient is comfortable with a serum creatinine of 400umol/L (without hyperkalemia, without uremic symptoms, without severe acidosis and without signs of congestive heart failure) I would recommend the creation of an AV fistula for dialysis in the near future rather than admit the patient for immediate dialysis.

by velavela, 13 May 2012 05:26
Chee YoongChee Yoong 11 May 2012 00:52
in discussion Hidden / Per page discussions » Ward Rounds 1

I don't know all, but i do know these conditions need urgent dialysis:

  • Patients who have persistent hyperkalemia despite medical treatment,
  • Patients with uremic complications eg encephalopathy, pericarditis
  • Patients who have blood urea levels above 7mmol/L (unsure about this)
  • Patients with severe metabolic acidosis
by Chee YoongChee Yoong, 11 May 2012 00:52

Those of you who wish to read a brief account of the Lancet article can give me your email addresses and I will email it to you. Those who prefer to read the original article on cystic fibrosis may please see the May 30th 2009 issue of the Lancet.

Re:
velavela 10 Jun 2009 11:40
in discussion Hidden / Per page discussions » The Clinical Problem

Recurrent lung infections, purulent sputum, clubbing made you suspect bronchiectasis. Your suspicion is justified but you have made the diagnosis of bronchiectasis without asking for the lung findings. Shouldn't you consider other possible causes like lung abscess.

His stools are bulky and float in the toilet. So you suspect fat malabsorption. This is justified. But then you straightaway attribute it to pancreatic involvement. How are you so sure? Why can't it be a malabsorption syndrome due to intestinal lipase deficiency.

You link the azoospermia with bronchiectasis and chronic pancreatitis and come up with the diagnosis of cystic fibrosis. This is justitified but my point is: you have not established bronchiectasis or chronic pancreatitis yet.

You asked whether the sweat test was done. Yes it was done and the chloride value was more than 60mmol/L. Now, this sweat test confirms the diagnosis of cystic fibrosis and your diagnosis (like the diagnosis of a few others) is correct. But I would have preferred it if you had asked for the lung findings on auscultation (coarse creps bilaterally), asked for the organism identified as the cause of his lung infection (Pseudomonas aeruginosa is a rare cause of lung infections except in cystic fibrosis) and asked for his blood sugar value (elevated because chronic pancreatitis causes diabetes) before you made the diagnosis.

Re: by velavela, 10 Jun 2009 11:40

this is a non specific question and hence cannot be answered. Organomegaly? Which organ?

Re: round 2 by velavela, 10 Jun 2009 11:22
KuganKugan 09 Jun 2009 16:56
in discussion Hidden / Per page discussions » The Clinical Problem

Cystic fibrosis:

Reason:
1.-history of chronic recurrent lung infection since childhood
- obstructive lung infection with purulent sputum and clubbing suggest bronchiectasis which is can be caused by cystic fibrosis

2. Infertility-azoospermia: absence of sperm in semen.patients with cystic fibrosis commonly known to have congenital absence of vas deferens (bilateral).This explains why there is no sperms.

3.stools are bulky and steotorrhea: this indicates lack digestion of fat ( lack of lipase?) i think back the involvement of pancreas in cystic fibrosis;thick secretions will block the enzymatic release from pancreas; it will lead to failure to absorb important nutrients ( including Lipid due to deficiency of lipase). This supported by failure of growth due to malnutrition.

my questions:any investigations done to rule out cystic fibrosis such as sweat test?

by KuganKugan, 09 Jun 2009 16:56

heh.. i think u can only ask 1 question at a time… i help dr vela tell you :P
hahaha… so maybe u want to rephrase or choose only 1 question…

Re: question by Zhi YongZhi Yong, 09 Jun 2009 14:47

any history of sinusitis or otitis media since childhood?
Any family member has the similar symptoms like him?
Does he has hypertension or diabetes mellitus?
Is he a smoker?
Any history of jaundice?

question by Cheng YapCheng Yap, 09 Jun 2009 12:25

on examination, does he have any organomegaly?

Re: round 2 by Zhi YongZhi Yong, 09 Jun 2009 09:32

he is underweight for his age and height at the moment. No details of growth in infancy are available.

Re: Question by velavela, 08 Jun 2009 23:38

antibiotics, often injectable antibiotics, are given for his cough

Re: round 2 by velavela, 08 Jun 2009 23:36

what medication is he on for his cough?

Re: round 2 by Zhi YongZhi Yong, 08 Jun 2009 14:12

How is the development during neonate's period? Any failure to thrive?

Re: Question by Jen ErnJen Ern, 08 Jun 2009 14:10

for respiratory infections

Re: round 2 by velavela, 08 Jun 2009 14:05

what were these hospital admissions for?

Re: round 2 by Zhi YongZhi Yong, 08 Jun 2009 13:54

Yes, many times

Re: round 2 by velavela, 08 Jun 2009 12:44

has he ever had any hospital admissions for any reason before this, from birth till now?

Re: round 2 by Zhi YongZhi Yong, 08 Jun 2009 11:47

NO hearing loss

Re: Question by velavela, 08 Jun 2009 08:59

No dry skin. No bleeding tendencies, no pathological fractures

Re: round 2 by velavela, 08 Jun 2009 08:58

Does he have hearing loss?

Question by Jen ErnJen Ern, 07 Jun 2009 13:48
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