PCL 9

PCL 9: Complications

Information from text

· 32 yrs old, Female

· Feeling weaker by hour

· Took her insulin injection before meal

· Going back to Melbourne

· She was feeling weak in her limbs.

· Suddenly became unconscious (but can still feel her surroundings) – Hypotension & Hypoglycaemia

· Sent to hospital

· Has Type 1 Diabetes Mellitus

· Reactive pupils

· GCS 10 (Coma Scale - Moderately Severe)

· BP 95/68 (LOW)

· Hypoglycaemia (TOOK INSULIN JAB)

· Dehydrated (Because of Diarrhoea)

· Neurologic Symptoms (Caused by neurotoxins)

· Shallow breathing with oxygen saturation of 92% (Normal is 100% O2 saturation with oxygen mask)

· Heart Rate 60bpm (NORMAL)

· Commenced on IV fluids (Because of dehydration) most probably normal saline solution - isotonic

· Felt a silver bracelet burning her hand as soon as she held it (ate seafood????)

· Was not able to speak properly as her tongue felt fuller (Allergy)

· Weird tingling sensation around mouth and tongue and started spreading across her limbs (Why?? – Neurological??)

· Experience Vertigo (Possibly caused by hypotension)

· Peripheral Oedema (in lower limbs)

· Low Urine Output

· Was prescribed diuretics and anti-histamines.

· Lab urine test results

o Albumin – 3.2g/24hrs (normally <0.1g/24hrs) HIGH!!!!!

o Creatinine clearance – 50 ml/min (normal 125 ml/min)

o Cholesterol 7mmol/L

Differential Diagnosis

1. Food poisoning leading to acute renal failure!

2. Nephrotic Syndrome

3. T1DM

Learning Issues

Type 1 Diabetes Mellitus + ****Nephrotic Syndrome****

1. Definition + Incidence (1ppl) - Shuhaibah

2. Pathophysiology (2 ppl) – Meena & Irene

3. Signs & Symptoms (1ppl) – Akmez

4. Causes + Risk Factors (1ppl) – HaiSherng

5. Complications (2ppl) - LiTatt, TinYee

a. Renal Failure & How do you investigate it? (1ppl) – Alvin

6. Investigations***** (1ppl) – ChingMei

7. Treatment and Management***** (2ppl) – Thomas & ZhiMei

*****Focus on Nephrotic Syndrome