Thursday, January 13th 2010

PHYSICIAN INCHARGE:
IA : dr. Nicholas dr. Vidia, dr. Sapto
IB : dr. Nurike, dr. Ardhi
II : dr. Riza
III : Prof. DR. dr. Handono Kalim, SpPD-KR

MODERATOR: Prof. DR. dr. A. Rudijanto, Sp.PD-KEMD

 Summary of Data Base
Male/34 y.o/W 24 A

Chief Complain : seizure

Patient suddenly had seizure while being hemodialyzed in

the first 1,5 hour, for 15 minutes, unconscious, and
accompanied with frequent vomiting which contained
residual food. Just before he had seizure, the nurse at
hemodialyze room injected something into the machine to
prevent the blood from clotting.

Patient had been hemodialyzed for 15 months and in this

last 6 months patient had it thrice a week.

Patient never had the same experience before.

 Physical examination
BP = 160/100 mmHg PR = 88 bpm RR = 24 tpm Tax = 36,8 C

General appearance looked moderately ill Agitated, looked normoweight

Head Anemic - Icteric -
Neck JVP R + 2 cmH2O; 30
Thorax: Cor: Ictus invisible and palpable at MCL ICS V sinistra
LHM: MCL sinistra, Cardiac waist (+)
RHM: SL dextra
S1, S2 single, no murmur

Lung: Symmetric, SF D = S s s vv Rh - - Wh - -
ss vv - - --
ss vv - - --

Abdomen Soefl, bowel sound + normal, liver span 10 cm, troube space
tympani
Extremities Warm, edema -/-
 Laboratory finding
Lab Value Lab Value

Leukocyte 8.100 3.500-10.000/L Natrium 145 136-145 mmol / L

Kalium 4,08 3,5-5,0 mmol / L

Haemoglobine 16,0 11,0-16,5 g/dl Chlorida 103 98-106 mmol / L

MCV 86 80-97 Calcium 9,6 7,6-11,0 mg/dL

MCH 29,8 26,5-33,5 Phosphor 3,41 2,5-7,0 mg/dL

PCV 46,2 35-50% RBS 95

Trombocyte 159.000 150.000- SGOT 25 11-41U/L

390.000/L

Ureum 128,3 10-50 mg/dL SGPT 50 10-41U/L

Creatinine 12,10 0,7-1,5 mg/dL eGFR 7,30

 CUE AND CLUE PL IDx PDx PTx PMo

Male/34 yo 1. 1.1. Restless leg Ferritin Kidney diet 1900 kcal/day, Subjec
Seizure while being Seizure, syndrome Serum protein 30g/day, low salt tive
hemodialyzed in the restlesne 1.2. Dialysis EEG Fluid restriction BP
first 1,5 hour, for 15 ss Disequilibrium O2 2-4 Lpm (NC) HR
minutes, unconscious, Syndrome HD RR
and accompanied with 1.3. Dialysis
frequent vomiting Encephalopathy
Just before he had Syndrome
seizure, the nurse at
hemodialyze room
injected something into
the machine to prevent
the blood from clotting
Hemodialyzed for 15
months and in this last
6 months patient had it
thrice a week
At ward, patient
became agitated
BP:160/100
PR:88
RR:24
Ur:128,3
Cr:12,1
eGFR:7,30
 CUE AND CLUE PL IDx PDx PTx PMo
Male/34 yo 2. CKD 2.1.Chronic Abdomina Kidney diet 1900 kcal/day, Subjec
Hemodialyzed for 15 stage 5 pyelonephritis l USG protein 30g/day, low salt tive
months and in this last on 2.2. GNC Kidney Fluid restriction BP
6 months patient had it routine biopsy if O2 2-4 Lpm (NC) HR
thrice a week HD necessary HD RR
BP:160/100
PR:88
RR:24
Ur:128,3
Cr:12,1
eGFR:7,30

Male/34 yo 3. 3.1. Fundusco Captopril 2x25 mg (po) Subjec

BP:160/100 Hyperten Renoparenchy py tive
PR:88 sion mal BP
stage 2 hypertension HR
3.2. Essential
hypertension