PLENARY DISCUSSION OF URINARY SYSTEM BLOCK Time schedule: March 18, 2010 14.00-17.

00 AM Objective After plenary discussion the students are able to: 1. Explain the organ or part of the body that abnormal related the symptom (patient complaint), the changes process from normal into pathologic condition. 2. Explain the etiology and risk factor of kidney disorder related the symptom and sign. 3. Explain the pathogenesis of kidney disorder related the symptom and sign. 4. Explain the pathophisiology of kidney disorder related the symptom and sign. 5. Explain the diagnosis of kidney disorder related the symptom and sign. 6. Explain the management of kidney disorder related the symptom and sign. 7. Explain the complication of kidney disorder related the symptom and sign. 8. Explain the prognosis of kidney disorder related the symptom and sign. 9. Explain the role of family doctor in the management of kidney disorder related the symptom and sign. 10. Explain the adjustment of drug treatment for the patient with kidney function disorder. A 76-year-old man referred to the center hospital because decrease of consciousness. He had open surgical resection of Colon Carcinoma as long as 20 cm in central hospital one year ago and continued by radiotherapy for 3 month. After radiotherapy he often experience of nausea and diarrhea. 1,5 month ago he take care at center hospital to be conducted colostomy. He discharge from the hospital but still have low serum potassium problem and obtain the treatment Aspar K 3x2, Tyarid 2x200 mg?, ISDN 3x5 mg, Aloclair gargle 3x1, Elkana 2x1, and valsartan 1x80 mg . 10 days ago the patient condition worse so he take care in a private hospital Magelang, he obtain the treatment: NaCl infuse 20 drop/mnt, Broadcet inj 2x1g, Rantin 3x1 amp, Antrain inj if necessary, Transfusion 500 cc PRC and oral treatment: CaCO3 3x1, Q ten 2x1, B Comp Vitamin 2x1, Analsik 3x1, Imboost 2x cth I, CPG 1x1, ISDN 1x1 . When the doctors allow him to discharge his consciousness suddenly decrease then the doctor referred him to the center hospital. No history of heart, lung, and kidney disease. He has mild hypertension. He has habit drink of tea but no smoking. He had not urination problem until he take care in private hospital Magelang but information for the condition at the last time before he refer to the center hospital not clear. Glasgow Coma Scale: E2V1M2 Vital Sign BP: 125/85 mmHg, Pulse: 78 beat per minute, RR: 28 x/min, t: 38,5 0 C First day Laboratory

WBC 47,3 Hb. 10,1 Hct 29 Plt 73 Blood Glucose 78 Tx D 40% Ro Photo: Heart and Lung: no abnormality detected Head CT Scanning: Cerebral Atrophy (+), Infarct (-), Cerebral Bleeding (-). Tx: Broadcet 4x500mg Piracetam 4x3 g Laboratory 12:45 PM GOT 61 GPT 35 Ureum 124 Creatinin 5,4 As Urat 7,4 Na+ 120 (135-147) K+ low ( 3,5-5,0) Cl- 99 (100-106) Tx koreksi KCl 1 flash Infus KN Mg3 Laboratory 06:08 PM Blood Gas Analysis pH 7,5 PCO2 23 PO2 138 BE -4,2 TCO2 18,7 HCO3 18 SO2 99 Na+ 134 K+ 2,3 Cl- 106 Laboratory 22:58 PM AT 71 Blood Glucose 105 Ureum: 135 Creatinin 2 As Urat 7,8 Cholesterol 101 Trigliserid 223 HDL 3 LDL 15 Urine Volume (-) Second days Infus KN Mg3 + NaCl 3%

Laboratory 09:11 AM Blood Glucose 291 Laboratory 01:36 PM Total Protein 5,7 Albumin 1,9 Globulin 3,8 Na+ 123 K+ low Cl- 102 Laboratory 10:49 PM Urine laboratory: Urine Protein: +3 Reduction: + Leucocytes >60 Red Blood Cell full Laboratory 07.40 PM PLT 59 Total Protein 4,9 Albumin 1,8 Globulin 3,1 Ureum: 141 Creatinin 4,7 As Urat 7,1 Na+ 105 K+ low Cl- 90 Mg+ 1,7 Laboratory 08:32 PM Na+ 114 K+ low Cl- 91 Urine Volume 150 cc/24 jam Third days Tx: change Broadcet into Tripanem 500mg/24 hr Laboratory 09:25 PM (Pre HD) Hb 9,8 AT 81 HBsAg negative WBC 18,5 Blood Type A Ureum: 178 Creatinin 4,2 As Urat 7,8 Na+ 1132 K+ 2,8 Cl- 111 Urine Volume: 200cc/24 hr Fourth days Laboratory 00:26 AM Blood Glucose 312 Ureum: 93 Creatinin 1,8 Urine Volume: (-)

Five days Laboratory 02:00 PM Blood Glucose: 360 Ureum: 181 Creatinin 4,9 Na+ 145 K+ 4,8 Cl- 107