Case study: Hypertension AH was found by his GP during a routine check-up to have a BP of 180/100 mmHg.

Mr AH is 58 years old, smokes 20 cigarettes a day, drinks several pints each night, has a body mass index (BMI) of 28, but is otherwise healthy. His father died of heart trouble in his 50s. 1. What would be the first steps in the management of Mr AH? Two months later Mr AHs BP was 170/98 mmHg. 2. Suggest clinical tests that might be carried out: 3. What active treatment is he likely to receive? 4. Why was the bendroflumethiazide every morning? 5. Given the poor response to bendroflumethiazide, should the dose be increased to 5 mg? 6. Draw up a plan with the various steps to continue the patients manageme nt: 7. What counselling is appropriate for Mr AH if he subsequently receives lisinopril (2.5 mg/day) in addition to bendroflumethiazide? 9. What are the goals of treatment for Mr AH?

Case study: diabetes and renal impairment CM is a 27-year-old white woman with type 1 diabetes diagnosed at age 14 when she presented with diabetic ketoacidosis. Her initial insulin treatment was complicated by poor glycaemic control, frequent hypoglycaemia and weight gain. Two years ago she developed hypertension, which was treated with bendroflumethiazide, 5mg daily. At that time, her blood urea level was 8.2 mmol/L, serum creatinine was 80 mol/L, and dipstick urinalysis was negative for protein. She was also noted to have non-proliferative diabetic retinopathy, and given a course of laser treatment. She has now been admitted via A&E complaining of nausea and vomiting. On examination, she was dehydrated and her breath smelled of ketones. She was conscious and alert. Her finger-prick blood glucose was 25.4 mmol/L and the urine dipstick was strongly positive for glucose, ketones and protein. She was diagnosed as being in diabetic ketoacidosis and was transferred to the intensive care unit for further management. On admission to the intensive care unit her laboratory results were as follows:
Na+ 127 mmol/L (135150 mmol/L) K+ 4.5 mmol/L (3.55.2 mmol/L) Blood pH 7.15 (7.367.44) Base excess 20.9 mmol/L Bicarbonate 5.8 mmol/L (2231 mmol/L) Urea 18.3 mmol/L (3.55.2 mmol/L) Creatinine 546 micromol/L (60110 micromol/L) Glucose 40.1 mmol/L HbA1c (3.96.1%)

Her weight is 54 kg, and she is 160 cm tall.

Questions
1 What is diabetic ketoacidosis? 2 Calculate CMs renal function using both the MDRD equation and the CockcroftGault formula. 3 What is the likely cause of CMs renal impairment? 4 What pharmacological and other interventions could be employed to reduce the risk of problems? 5 Comment on this dose of gentamicin. 6 What dose would you recommend?

CM adalah seorang wanita kulit putih 27 tahun dengan diabetes tipe 1 didiagnosis pada usia 14 tahun ketika ia disajikan dengan ketoasidosis diabetikum. Pengobatan insulin awal nya rumit oleh kontrol glikemik yang buruk, sering hipoglikemia dan berat badan. Dua tahun lalu ia menderita hipertensi, yang

diobati dengan bendroflumethiazide, 5mg sehari-hari. Pada saat itu, tingkat urea darahnya adalah 8,2 mmol / L, kreatinin serum adalah 80 mol / L, dan dipstick urine negatif untuk protein. Dia juga tercatat memiliki retinopati diabetes non-proliferasi, dan diberikan pengobatan laser. Dia kini telah diakui melalui A & E mengeluh mual dan muntah. Pada pemeriksaan, dia mengalami dehidrasi dan napas berbau keton. Her glukosa darah jari-tusukan adalah 25,4 mmol / L dan dipstick urine itu sangat positif untuk glukosa, keton dan protein. Dia didiagnosis sebagai dalam ketoasidosis diabetik dan dipindahkan ke unit perawatan intensif untuk pengelolaan selanjutnya.

Pada masuk ke unit perawatan intensif hasil laboratorium-nya adalah sebagai berikut: Na + 127 mmol / L (135-150 mmol / L) K + 4.5 mmol / L (3,5-5,2 mmol / L) PH darah 7.15 (7,36-7,44) Basis kelebihan -20,9 mmol / L Bikarbonat 5,8 mmol / L (22-31 mmol / L) Urea 18,3 mmol / L (3,5-5,2 mmol / L) Kreatinin 546 mikromol / L (60-110 mikromol / L) Glukosa 40,1 mmol / L HbA1c (3,9-6,1%) Berat badannya 54 kg, dan dia adalah 160 cm. pertanyaan
1. Apa ketoasidosis diabetik? 2. Hitung fungsi ginjal CM menggunakan kedua persamaan MDRD dan formula Cockcroft-Gault. 3. Apa penyebab kemungkinan kerusakan ginjal CM? 4. Apa farmakologis dan intervensi lainnya dapat digunakan untuk mengurangi risiko masalah? 5. Komentar pada dosis ini gentamisin. 6. Apa dosis yang akan Anda rekomendasikan?

WWW.medsafe.govt.nz/profs/datasheet/g/Gentam icininj.pdf