Had a pt 36 yr old with 8 wks pregnancy come in today with seizures and metabolic Acidosis. There was a h/o oral consumption of 30 ml of #eucalyptus oil.
There was no kidney dysfunction. I was called for Rx of Acidosis. I have not seen eucalyptus oil poisoning before.
In adults, death is commonly seen after ingestion of 30 ml, but can be encountered after 4-5 ml also. ncbi.nlm.nih.gov/pmc/articles/P…
In children, a dose of 2-3 mL can induce mild CNS depression with drowsiness and/or dizziness and ataxia. A dose of ≥5 mL can induce significant CNS depression with coma.
There is good evidence that beta blocker use in hemodialysis pts (#CKD 5D) reduces mortality. Here is a list of Beta Blockers commonly used. The tweet that follows this one has a poll, pl answer and RT/repost for wider reach. #nephtwitter
What is the Beta Blocker that you use in your (#CKD 5D) #Hemodialysis pts? If it's a drug other than these four, pl reply to the poll with an answer. Please RT/repost for wider reach. #nephtwitter
Summary of Three Randomized Controlled Trials (RCTs) That Have Studied Beta-Blockers in #Hemodialysis Patients
👉Cice et al observed that after a two-year follow-up, the included patients who received carvedilol had lower mortality and hospital admissions than the patients who received placebo.
👉Agarwal et al showed greater blood pressure reduction with atenolol compared with lisinopril, but was interrupted earlier because of serious complications in the lisinopril group.
👉Roberts et al performed a multicenter pilot randomized controlled trial, but failed to compare carvedilol with placebo as they could not recruit the planned sample size. The goal was to randomize 150 patients, but they only managed to get a population of 49 patients, due to a high dropout rate and several complications.
ECG of a 65 yr old male pt who was admitted with AoCKD, Screat of 4.1 mg (was 2.6 mg 3m ago). K was 9.0
What changes of hyperkalemia do you see on this ecg? Why is there no Bradycardia or "sine wave" pattern? How would you Rx this? #Meded#nephtwitter
The possibility of pseudohyperkalemia was considered especially blood sample lysis. Nevertheless Rx of hyperkalemia was started in right earnest and a repeat fresh sample of blood was sent, drawn without applying a torniquet.
(Pic courtesy : ijcasereportsandimages.com/archive/articl…)
The repeat sample came back with a K of 8.1 meq. So this was true hyperkalemia.
Medical mgmt of K and the option of dialysis was discussed with the pt and relatives.
A Thread.
The Indian Government has increased the gap btw the two doses of #COVID19 vaccination to 3 to 4 months now, ostensibly to improve protection but actually bcos of vaccine stock deficiency. This should NOT apply to Chronic Kidney Disease pts, #Dialysis & Transplant pts.
CKD pts, #dialysis and Transplant pts run a very high risk of morbidity and mortality (4 fold) with #COVID19 infection, much higher than diabetics and pts with heart disease or asthma (1.2 to 2 fold) nature.com/articles/s4158…
Data from India has also shown high mortality (38%) in dialysis pts. Study by @MayuriTrivedi80 et al
This is a Thread about the Indian caregiver.
Most #CKD & #Dialysis pts come with their relatives as caregivers when they come for an OP consult. Usually it is the spouse & sometimes, the children. I make it a point to enquire about their health even though they are not my pts 1/n
I will tell you why I do that with a couple of real-life events. My 55 yr old #CKD Pt came without her husband for a consult which was unusual. When I asked her, she started bawling out in distress, saying that he'd died of a heart attack the previous month. 2/n
He was 60 years of age and hypertensive, but it appears that he never bothered to go for his regular BP check or for that matter an annual cardiac check. I didn't know of this & wondered at the time, should I have asked him how he was during his many visits to my OP chambers? 3/n