Coma patient ! Endocrine or nephro Patient?
Yesterday is the last day of working day ,Friday. I as a nephrology MO incharge of periphery (means i will take pager and see the patient in whole Hospital and referral from district hospital) expected a cool and relax day as most of the expected problem already been settled down. Out of my expectation, i received a pager at 11.00 am. from endocrine ward. They referred one case for me for metabolic acidosis and renal impairment. As I go there, the consultant nephrologist LSL told me that this patient was wrongly admitted in their ward.
This patient is from Selama ,Perak. A diabetic and hypertensive patient actually got chronic renal failure(baseline crea unknown) defaulted penang GH follow up and presented to Selama Hospital for loss of consciousness.Glucose strip revealed patient is hypoglycaemia(1.3mmol/dl). 50 cc detrose 50% given to patient. Patient not regain consciousness despite sugar improved.Patient is intubated but unable to find ventilator in Ipoh so sent to us for ventilator support. At here,CXR appeared congested lung ,ABG shows metabolic acidosis (pH7.121 HCO3 13),Blood urea 31.Creatinine awaiting.paedal oedema and basal crepitation on examination. Neurological examination no significant focal deficit and pupil is equal on both side.
When I reviewed the patient there ,patient is on Dextrose 10% and ventilated with sedation.Vital side is stable and patient is afebrile.
Glucose is still at lowish side(3.2).Ct brain is pending.
I am not quite satisfy with the thing is that how can you say it is coma secondary to uraemic encephalopathy(renal causes) and ask us to take over the case when the CT is not yet back and glucose is not fully corrected. Is it the commonest causes for coma in Malaysia is uraemic encephalopathy?
Due to the divided medical ward according to speciality, this type of incidence always happened in Penang GH. Every patient who got chronic renal failure,end stage renal failure will normally admitted to our ward or asked to be transferred to our ward regardless they are sick due to UTI, pneumonia ,cellulitis or other causes. This only won't happened when there is a very clear cut causes for admission like massive haemoptysis ,severe per rectum bleeding .
Notes:Causes of coma see here
This patient is from Selama ,Perak. A diabetic and hypertensive patient actually got chronic renal failure(baseline crea unknown) defaulted penang GH follow up and presented to Selama Hospital for loss of consciousness.Glucose strip revealed patient is hypoglycaemia(1.3mmol/dl). 50 cc detrose 50% given to patient. Patient not regain consciousness despite sugar improved.Patient is intubated but unable to find ventilator in Ipoh so sent to us for ventilator support. At here,CXR appeared congested lung ,ABG shows metabolic acidosis (pH7.121 HCO3 13),Blood urea 31.Creatinine awaiting.paedal oedema and basal crepitation on examination. Neurological examination no significant focal deficit and pupil is equal on both side.
When I reviewed the patient there ,patient is on Dextrose 10% and ventilated with sedation.Vital side is stable and patient is afebrile.
Glucose is still at lowish side(3.2).Ct brain is pending.
I am not quite satisfy with the thing is that how can you say it is coma secondary to uraemic encephalopathy(renal causes) and ask us to take over the case when the CT is not yet back and glucose is not fully corrected. Is it the commonest causes for coma in Malaysia is uraemic encephalopathy?
Due to the divided medical ward according to speciality, this type of incidence always happened in Penang GH. Every patient who got chronic renal failure,end stage renal failure will normally admitted to our ward or asked to be transferred to our ward regardless they are sick due to UTI, pneumonia ,cellulitis or other causes. This only won't happened when there is a very clear cut causes for admission like massive haemoptysis ,severe per rectum bleeding .
Notes:Causes of coma see here
posted by M K at
12:34 AM
1 Comments:
What ever the causes of coma, this patient should be managed in the ICU since she was ventilated. Nephro point of view, just provide dialysis, endocrine, just correct the hypoglycaemia, and neurology, just rule out stroke. Due to the 'compartmentalization' of the medical unit, this lady belongs to 'no-man-land'.
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