Why the creatinine was elevated!
To recap:
At 4:30 am his repeat BMP returns
139
106
29
106
4.5
20
2.9
7.9
His creatinine kinase levels where 390 at 9 pm and 345 at 4:30 am
When I saw him at 9 am, he had normal BP lying and standing, with a pulse around 90 at all times. He had had a bladder scan that showed minimal urine, and his output was around 5 cc/hour.
So the question for you is what do you do now? You can order more tests. You can order treatment. You could get a consult. You can criticize the new intern and resident.
======
My answer
We had excluded obstruction, and in my mind the differential diagnosis was predominantly v...
Source: DB's Medical Rants - July 15, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Acid-Base & Lytes Attending Rounds Source Type: blogs
Goodbye, nephrotic syndrome!
Joanna posted this intriguing and wonderful tale of nephrotic syndrome reversed with wheat elimination:
No more nephrotic syndrome since starting
Wheat Belly–this is MASSIVE. I need to share my story Dr Davis.
I’m 30, I had heavy proteinuria [protein loss in the urine] for years. I went strictly wheat-free in July, 2012, and today I discovered its down to 0.5 g [per day]. No meds, just my interest in nutrition, in particular my 10 months on Wheat Belly. I’ve lost 20 kg [44 pounds], I weigh 54 kg [118.8 pounds] now, zero fluid retention, and the receptionist at the doctor’s office didn’t recogn...
Source: Wheat Belly Blog - May 16, 2013 Category: Cardiology Authors: Dr. Davis Tags: Wheat-elimination success stories Source Type: blogs
USMLE Questions – Characteristic Disease Findings
The United States Medical Licensing Examination (USMLE) is designed to emphasize knowledge of clinical scenarios and clinical pearls, even on Step I. Listed below are some commonly encountered disease findings and characteristics.
Feature
Disease
45, X chromosome
Turner’s syndrome
5-HIAA increased in urine
Carcinoid syndrome
Aganglionic rectum
Hirschsrpung’s disease
Apple-core sign on barium enema
Colon cancer
Arched back (opisthotonos)
Tetanus
Argyll-Robertson pupil
Syphilis
Ash leaf on forehead
Tuberous sclerosis
Auer rods
Acute myelogenous leukemia
Austin Flint murmur
Aortic regurgitation...
Source: Inside Surgery - January 18, 2013 Category: Surgeons Authors: Editor Tags: Surgpedia USMLE diseases findings VMA water hammer pulse Source Type: blogs
