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RISS 인기검색어
- 검색키워드
- 저자 : ( Ibrahim Cetindagli ) (검색결과 2 건)
- 무료
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( Veysel Ozalper ),( Ibrahim Cetindagli ),( Ergenekon Karagoz ),( Emrullah Solmazgul ),( Cihan Top ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Objective: Hyperkalemia is a common and serious clinical problem that occurs often due to impaired urinary potassium excretion because of acute or chronic kidney disease or drugs that effect renin-angiotensin-aldosterone axis. We report a hyperkalemic patient with 9.0mEq/L without any ECG changes. Case Report: A 86-year-old-woman suffering fatigue within two days had admitted emergency service because of sudden bilateral lower extremity paralysis. She had esential hypertension, ischemic heart disease and chronic kidney disease and was using Spironolactone, silazopril, asetilsalisilik, isosorbid-5-mononitrat ve karvedilol. Initial neurological examination of extremities was; 2/5 of lower extremity, 4/5 of upper extremity. Initial laboratory fi ndings potassium:9,1mmol/L, sodium:141mmol/L, creatinine: 1,9mg/dl. In his arterial blood gas analyse, pH:7.27, HCO3:16mEq/L, pCO2:30mm- Hg, potassium:9,1mmol/L. Spironolactone and silazopril treatment had stopped. With an intensive electrolyte-follow-up, She was commenced on intravenous fl uid, injection calcium gluconate and glucose/insulin infusion. Within two hours of treatment her potassium level decreased by 1.5 mmol/L. After eight hours of intensive treatment, potassium level reached below 6,5mEq/L. Five Days later, after three days of close follow-up with normal potassium level, the patient had discharged. Conclusion: ECG differancies like fl attening in U wawe, expansion in QRS, taper in T wawe, arrhytmias, asystoles can be seen in hypercalemia. Especially in the circumstances that serum potassium level is above 8 mEq/L ECG differancy is expected to be seen. So that, it is suggested that biochemical elevation in hypercalemic cases is verifi ed with ECG. Although it is rarely seen like in our cases, it shouldn`t be forgotten that severe hypercalemia can be seen without ECG differancy.
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Polyglandular Autoimmune Syndrome Type-Ii Presented with Acute Renal Injury
( Veysel Ozalper ),( Ibrahim Cetindagli ),( Omer Tekin ),( Yalcin Onem ),( Yusuf Hancerli ),( Eylem Cagiltay ),( Barbaros Basbug ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Introduction: Polyglandular autoimmune syndrome (PAS) is a rare disease, characterized by failure of more than two endocrine glands. Type-II of this syndrome is the most common of the immunoendocrinopathy syndromes and characterized by the obligatory occurrence of autoimmune Addison disease in combination with thyroid autoimmune diseases and/or type-I diabetes mellitus. We report a case of PAS-TypeII presented with prerenal acute renal failure. Case Report: A twenty-two-year-old man had a hyperpigmentation of gingiva within three months, fatigue and amnesia within two months, emesis and vomit within one months, admitted because of persistent vomiting and ten kilogram weight loss. Initial laboratory fi ndings were: urea:87mg/dl, kreatinin:1.31mg/dl, sodium:125mmol/L, potassium: 5.6mmol/L, albumin:4.16g/dl, calcium:123mg/dl. In his arterial blood gas analyse, he had a normal anion gap metabolic asidosis. pH:7.24, HCO3:12.8mEq/L, pCO2:30mm- Hg. He had a prerenal acute renal injury because of persistent vomiting. Other laboratory fi ndings were Hemoglobine:12.9g/dl, TSH:0,004 uIU/ml, FreeT4:2,16ng/dl, Anti-TPO:876 IU/ml, AntiThyroglobulin:9,72IU/ml, Cpeptid:0,27ng/ml, Kortizol:0,1ug/dl, ACTH:22,8pg/ml, HbA1c: %4,7.. A thyroid-scintigraphy showed diffuse homogenous thyroid involvement. His pituitary magnetic-resonance-imaging, thoracoabdominal- tomography and esophagogastroscopy was normal. Based on his fi ndings above and intravenous ACTH stimulation test, adrenal insuffi ency and otoimmune thyroiditis were diagnosed. General condition improved gradually following the administration of hydrocortisone, fl udrocortisone, thyromazol, propranolol. Conclusions: As a conclusion, in persistant vomiting patients, endocrine functions must be performed. A patient who presents with a single autoimmune diseases must be considered at risk of other autoimmune diseases. High index of suspicion, early recognition and treatment can be life-saving, particularly when there is adrenal and thyroid component.
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