Wednesday , October 5th 2011

PHYSICIANS INCHARGE: IA : dr. Ade, dr. Suyoso, dr. Widyo IB : dr. Dyah, dr. Satryo II : dr. M. hidayat III : dr. Atma Gunawan, SpPD-KGH MODERATOR: Dr. Gatoet Ismanoe ,Sp PD-KPTI

Summary of Data Base

Mr. Supriyadi/ 56yo/w 24b Chief Complain : nausea and vomiting

Patient suffered from nausea and vomiting since 1

week ago. Nausea almost every time he eat, sometime accompanied by vomiting. It made he lost his appetite. He said that since 10 days ago, his urine was reddish, especially when he felt pain on his back. But his urine become clear again when he drank more water. 20 days ago, there were 5 pieces of small stone came out when he passed urine.

he said that 6 months ago, his blood pressure was 160/.. But he never consumed antihypertension and never check his blood pressure anymore. he took pils pasak bumi and neorheumacyl almost everyday for about 6 years.

Physical examination
BP = 190/100 mmHg PR = 100 bpm General appearance looked moderatey ill Head Neck Thorax: Cor: Anemic JVP R + 2 cmH2O Ictus invisible and palpable at MCL ICS V S LHM ictus, heart waist + RHM: SL Dextra No additional hearth sound Symetric, SF D = S, s s v v s s vv s s vv Rh - - - Wh - - - RR = 20 tpm reg GCS 456 Tax : 37,0 C

Lung:

Abdomen

soefl, liver span 8 cm, troube space tympani, bowel sound normal

Extremities

Edema (-), anemic (-)

Laboratory finding
Lab Leukocyte Haemoglobine PCV Trombocyte SGOT Value 12,000 11.6 33.8 145,000 19
3.500-10.000/L

Lab Natrium Kalium Chlorida Calsium Phosphor Ureum

Value 123 7.79 102 8.7 12.34 256.0 136-145 mmol / L 3,5-5,0 mmol / L 98-106 mmol / L 7.6-1 1mg/dl 2.5-7.0 mg/dl 10-50 mg/dL

11,0-16,5 g/dl 35-50% 150.000390.000/L 11-41U/L

SGPT

15

10-41U/L

Creatinine RBS Albumin

eGFR

30.91 85 3.60
2.6

0,7-1,5 mg/dL

3,5-5,5 g/dL

Lab Urinalysis SG PH Leucocyte Nitrite Protein Glucose Erythrocyte Keton urine Urobilinogen Bilirubin 1.020 5.0 +3 + +4 + +5 -

Value

Lab 10 x Epithelia Cylinder Hyaline Granular Leukocyte Erythrocyte 40 x

Value + >200 20-25 +

Eritrosit
Leukocyte Crystal Bacteria

BLOOD GAS ANALISIS

pH pCO2 pO2 HCO3 O2 sat BE Conclussion : : : : : : : 7. 227 26.3 mmHg 104.8 mmHg 13.2 mmol/L 96.9 % -16.9 m mol/L metabolic acidosis

ECG 04/10/11

ECG (04/10/2011)
Sinus rhythm, heart rate 82 bpm Frontal Axis : normal Horizontal Axis : normal PR interval :0.16 QRS complex : 0.08 QT interval : 0.32 T tall in V3, V4, V5

Conclusion : Hyperkalemia

CXR 04-10-2011

CXR (04/10/11)
AP position, asymmetric
Trachea in the middle Soft tissue and bone thin Right and left phrenico-costalis angle are sharp Right and left hemidiaphragm are dome-shape Pulmo increase of bronchovascular in both of lung

area Cor CTR 49% Conclusion: Normal CXR

CUE AND CLUE Male/ 56 yo

PL

IDx

PDx

PTx

PMo

Nause and 1. CKD st vomiting 5 Reddish urine History of passed urine with small stone NSAID for 6 years BP 190/100 PR = 100 bpm
Leukocytosis 12,000 Ur 256 Cr 30.91 eGFR 2.6 K 7.99 Phosphor 12.34 Eritrosituri 5+ Proteinuria 4+ Leukosituria 3+ BGA metabolic acidosis ECG T tall in lead II, aVF, V3,V4, V5

1.1 Obstructive uropathy 1.2 GNC 1.2 PNC

BNO USG Abdomen

O2 2-4 lpm Iv plug Kidney diet 1900kcal/day Low salt <2g/day Prot 0.6-0.8g/kg/day Inj. Metoclopramide 3x 10mg Po omeprazole 2x 20mg
Hemodialisa

VS BP

CUE AND CLUE Male/ 56 yo

PL

IDx

PDx

PTx

PMo

Reddish urine 2. HT st 2 History of passed urine with small stone NSAID for 6 years
BP 190/100 PR = 100 bpm Lab : Leucocytosis 12,000 Ur 256 Cr 30.91 eGFR 2.6 K 7.99 Phosphor 12.34 Eritrosituri 5+ Proteinuria 4+ Leukosituria 3+

2.1 renal Funduscopy Low salt parenchymal Lipid profile Po Nifedipine 3x 10mg 2.2 primary HT

VS BP

CUE AND CLUE Male/ 56 yo

PL

IDx

PDx

PTx

PMo

Nause and vomiting Reddish urine History of passed urine with small stone

3.

3.1 due to Hiperpotas CKD st 5 semia

Insulin 10 iu iv D40% 2 flash Ca Gluconas 1 A

Hemodialisa as above

SE ECG

Ur 256 Cr 30.91 eGFR 2.6 K 7.99 Phosphor 12.34 ECG T tall in lead II, aVF, V3,V4, V5

CUE AND CLUE Male/ 56 yo

PL

IDx

PDx

PTx

PMo

Nause and 4. vomiting Dyspep NSAID for 6 years sia Leucocytosis syndro 12,000 me Ur 256 Cr 30.91 eGFR 2.6 Na 126 K 7.99

4.1 uremic gastropathy 4.2 NSAID gastropathy

Urea breath test

Inj. Metoclopramide 3x 10mg Po omeprazole 2x 20mg

subj

Male, 56 yo
Nause and vomiting Reddish urine History of passed urine with small stone Leukocyte 12,000 Eritrosituri 5+ Proteinuria 4+ Leukosituria 3+ Nitrit + 5. Asympt omatis UTI 5.1 Urine culture and sensitivity test Inj. Ceftriaxone 2x 1g Subj Tax CBC UL