Dr Pir Shah

1

The last time I had my renal function it was fine
I am not so sure about my Liver Function Test!

• Dr Pir Shah

2
History

• 74 year old patient presented in a Residential
  home.
• Lethargy, short of breath overnight,palpitations
  last less than 30 seconds that resolved
  spontaneously.
• No chest pain/no dib
• No infective history
• Bowels opening and no urinary symptoms

3
History
PMH Type II diabetes Hypertension Hypercholester
olemia Chronic renal impairment Left sided
ischaemic diabetic maculopathy Right background
diabetic retinopathy Previous CA
breast Beta-thalassaemia trait. Hyperkalaemia
4
History
DH Omeprazole 20mg OD Paracetamol 1g
QDS Simvastatin 40mg nocte Frusemide 20mg
OD Codeine 30mg QDS Mixtard 30 Temazepam 20mg
nocte Sertraline 50mg OD Capsaicin cream 0.025
5
Observation
Afebrile 84 bpm sinus BP 136/80 Rr 16
6
Examination

• Pt was seated, alert, well perfused periphery. no
  sunken eyes, good palor, generally weak, felt
  light-headed.
• CV heart sounds normal
• Res airway entry was fine and no added sounds
• GI sft, non tender.

7
Examination

• Neurology CNII-XII, no focal neurology noted.
• Need to rule out
• NO NOT A UTI
• 1. Anaemia
• 2. UE imbalance

8
Examination

• Plan
• 1. bloods
• 2. urine dipstick
• 3. Glucose dipstick

9
Potassium
K Urea
Creatinine
eGFR 6.3mmol/L 13.5mmol/L
118umol/L 40mL/min 5.5mmol/L
14.3mmol/L 125umol/L
37mL/min 6.5mmol/L 10.8mmol/L
113umol/L 42mL/min

10
Examination

• Potassium 6.5
• Pt was at Derby in the renal clinic talked to
• the nurse running the clinic and one of the
• registrars that was in clinic and made them
• aware of the Potassium.

11
Potassium
Potassium, the most abundant intracellular
cation. Potassium is obtained through the diet.
Common potassium-rich foods include meats, beans,
fruits, and potatoes. Gastrointestinal
absorption is complete, resulting in daily excess
intake of about 1 mEq/kg/d (60-100 mEq). Excess
is excreted through the kidneys (90) and the gut
(10). Potassium homeostasis is maintained
predominantly through the regulation of renal
excretion. The most important site of
regulation is the distal nephron, including the
distal convoluted tubule, the connecting tubule,
and the cortical collecting tubule, where
aldosterone receptors are present.
12
Potassium
Potassium, the most abundant intracellular
cation. Potassium is obtained through the diet.
Common potassium-rich foods include meats, beans,
fruits, and potatoes. Gastrointestinal
absorption is complete, resulting in daily excess
intake of about 1 mEq/kg/d (60-100 mEq). Excess
is excreted through the kidneys (90) and the gut
(10). Potassium homeostasis is maintained
predominantly through the regulation of renal
excretion. The most important site of
regulation is the distal nephron, including the
distal convoluted tubule, the connecting tubule,
and the cortical collecting tubule, where
aldosterone receptors are present.
13
Potassium
K intake is closely related to meat, vegetable,
and fruit ingestion and usually does not require
adjustment. However, foods (especially salt
substitutes) rich in K should generally be
avoided. Hyperkalemia is infrequent until
end-stage renal failure, when intake may need to
be restricted to 50 mmol/day. Mild
hyperkalemia (lt 6 mmol/L) can be treated by
reducing K intake and correcting metabolic
acidosis. More severe hyperkalemia (gt 6 mmol/L)
warrants urgent treatment.
14
Happy itching.