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腎臟內科臨床個案探討

腎臟內科臨床個案探討. 徐邦治醫師. 介紹. A 47-year-old male patient suffered from conscious disturbance noted this morning and had a history of alcoholism with alcohol drinking > 6 bottles per day about 20 years. He was admitted to 民間戒酒養護所 about two months ago.

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腎臟內科臨床個案探討

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  1. 腎臟內科臨床個案探討 徐邦治醫師

  2. 介紹 • A 47-year-old male patient suffered from conscious disturbance noted this morning and had a history of alcoholism with alcohol drinking > 6 bottles per day about 20 years. He was admitted to 民間戒酒養護所 about two months ago. • But conscious disturbance noted by民間戒酒養護所 at this morning and had some bottles at bedside. He was transferred to 嘉義榮民醫院 and noted severe metabolic acidosis and coma and respiratory failure, then on endotracheal tube and transferred to our hospital for further management.

  3. Physical examination • Conscious：deep coma、2TVital sign：BP：111/58 mmHg、BT：35℃、 RR：26次/min 、HR：98下/minSkin:Gnormal，no skin lesion HEENT:Gconjunctiva：not pale 、sclera：not ictericNeck：supple，no LAP，no JVEChest：symmetric 、BS：bilateral clearHeart：regular、no murmur、no abnormal pulsation Abdominal：soft、no tenderness，liver、spleen：not enlargementbowel sound：normal activeExtremity：no pitting edema、no clubbing fingerDigital：no tarry stool

  4. Laboratory data CBC/DC：WBC：25000/ul、Hb：13.8g/dl、 PLT：199000/ul、MCV：100.5 fl B12S53L21M4E2BCS：Na+：133.8、K+：5.72、Glucose：180、 GOT：18、BUN：19、Cre：2.3Cl-：100.5、 serum osmo：375、 serum ketone: negative、 serum lactate: negative、 Ca：1.83、IP：8.6ABG：PH：6.676、PCO2：24.5、PO2：170、HCO3-：2.9、ABE：-33.2、Sat：96%U/A：PH：6.0、RBC：0-1/HPF、WBC：0-2/HPF、Epithelial cell：0-2/HPF、Crystal：0、Cast：5-7/HPF、 Bact：0、Protein：1+、Ketone：+/-、OB：+/-Ethanol level：107 mg/dLMethanol level： 29.5 mg/dL (normal < 0.15 mg/dL)Head CT：mildly decreased attenuation is seen in the internal and external capsules

  5. Question 選擇題

  6. Question 1 The cause of high anion gap metabolic acidosis, which one answer is correct ? • IRenal tubular acidosis. • Diabetic ketoacidosis. • Diarrhea. • Vomiting. Ans: B

  7. Question 2 The cause of normal anion gap metabolic acidosis, which one answer is correct? • Ingestion of ammonium chloride. • Renal failure. • Methanol intoxication. • Use loop diuretics. Ans: A

  8. Question 3 What is the acid-base disturbance of this patient? • Respiratory acidosis. • Metabolic alkalosis. • Respiratory alkalosis. • Metabolic acidosis. Ans: D

  9. Question 4 What is the best diagnosis of this patient? • Alcoholic ketoacidosis. • Metformin intoxicztion. • Methanol intoxication. • Toluene intoxication Ans: C

  10. Question 5 Which answer is wrong about the treatment of this patient? • Ethanol. • Hemodialysis. • Fomepizole. • Hemoperfusion. Ans: D

  11. Question 6 What is most toxic metabolite of methanol intoxication? • Formic acid. • Acetic acid. • Oxalic acid. • Glycolic acid. Ans: A

  12. Question 7 What is used ethanol to treat methanol intoxication? • Because greater affinity for aldehyde dehydrogenase. • Because greater affinity for alcoholic dehydrogenase. • Because greater affinity for catalase-mediated metabolism. • Because to correct acidosis.. Ans: B

  13. Question 8 The most cause the eyes problem of methanol intoxication is? • Cataract. • Glaucoma. • Retinal hemorrhage. • Blindness. Ans: D

  14. Question 9 What is the best plasma ethanol concentration to treat methanol intoxication? • 0-100 mg/dl. • 100-200 mg/dl. • 200-300 mg/dl. • 300-400 mg/dl. Ans: B

  15. Question 10 What is the differential diagnosis of ethylene glycol intoxication from methanol intoxication? • Coma. • Crystalluria. • Seizure. • Dyspnea. Ans: B

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