وصف
Diabetes produces acute and chronic toxicity to vascular endothelium in the patients resulting in spikes in hyperglycemia due to exposure to postprandial glucose. This causes microvascular and macrovascular complications.Damage to blood vessels starts early in such conditions.CVD and diabetes are interrelated,treatment focuses on the shared pathophysiologic mechanism of the diseases.
ملخص
- The presentation revolved around a complex case of a 60-year-old male with acute kidney injury (AKI), heart failure with preserved ejection fraction (HFpEF), and diabetic foot ulcers, compounded by diabetic neuropathy and underlying hypertension and type 2 diabetes. The discussion emphasized a practical, guideline-based approach to managing such cases, highlighting the significance of recognizing potential complications.
- The initial evaluation highlighted the patient's symptoms: breathlessness, palpitations, and reduced urine output, alongside a painful, foul-smelling foot ulcer. Critical negative findings ruled out acute myocardial infarction (AMI), sepsis, and obstructive uropathy. A thorough medical history revealed long-standing diabetes, hypertension, and a diabetic foot ulcer being treated with multiple antibiotics and analgesics.
- Examination revealed tachypnea, edema, and signs of heart failure, with lab results showing elevated creatinine and NT-proBNP. Urine analysis suggested proteinuria and granular casts. Further investigations ruled out urinary stones, prostate hypertrophy, and osteomyelitis. A prior history of poorly controlled diabetes and existing kidney issues was noted.
- Drug-induced AKI, specifically due to NSAID use, was identified as the most likely cause. The importance of calculating eGFR and adjusting medication dosages was stressed, emphasizing caution with nephrotoxic drugs and managing blood glucose levels to prevent further renal damage.
- Management of the case involved fluid resuscitation, electrolyte correction, judicious diuretic use, and discontinuation of nephrotoxic drugs. The presentation also touched upon managing hypertension in diabetic patients and addressing diabetic neuropathy, emphasizing proper foot care and selecting appropriate medications.
- The discussion underscored the value of urine albumin-to-creatinine ratio (ACR) in monitoring CKD progression. The session concluded with an interactive exercise, reviewing the discharge medication summary and exploring potential modifications to optimize the patient's ongoing care. The importance of patient education, follow-up appointments, and the role of nephroprotective agents were also highlighted.
نموذج شهادة
حول المتحدثين
Dr Amit Kumar Dey
Apollo Sugar Clinics, Newtown, Kolkota
تعليقات
تعليقات
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