peraquat poisoning

Chronic kidney failure, also known as chronic renal failure, chronic renal disease, or chronic kidney disease, is a slow progressive loss of kidney function over a period of several years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. CKD is initially without specific symptoms and is generally only detected as an increase in serum creatinine or protein in the urine. Later on there is- increased urination, especially at night decreased urination blood in the urine (not a common symptom of chronic renal failure) urine that is cloudy or tea-coloured puffy eyes, hands, and feet (called edema) high blood pressure fatigue shortness of breath loss of appetite nausea and vomiting (this is a common symptom) thirst bad taste in the mouth or bad breath weight loss generalized, persistent itchy skin muscle twitching or cramping a yellowish-brown tint to the skin Pathology- A normal kidney contains approximately 1 million nephrons, each of which contributes to the total glomerular filtration rate (GFR). In the face of renal injury (regardless of the etiology), the kidney has an innate ability to maintain GFR, despite progressive destruction of nephrons, as the remaining healthy nephrons manifest hyperfiltration and compensatory hypertrophy. This nephron adaptability allows for continued normal clearance of plasma solutes. The hyperfiltration and hypertrophy of residual nephrons, although beneficial for the reasons noted, has been hypothesized to represent a major cause of progressive renal dysfunction. Causes- Type 1 or type 2 diabetes High blood pressure Glomerulonephritis Interstitial nephritis, an inflammation of the kidney’s tubules and surrounding structures Polycystic kidney disease Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers Recurrent kidney infection, also called pyelonephritis Types- Each patient is classified into one of the following 5 stages of CKD according to the progression of damage. Stage 1: Kidney damage with normal or increased GFR(>90 mL/min/1.73 m2) Stage 2: Mild reductionin GFR (60-89 mL/min/1.73 m2) Stage 3: Moderate reductionin GFR (30-59 mL/min/1.73 m2) Stage 4: Severe reductionin GFR (15-29 mL/min/1.73 m2) Stage 5: Kidney failure(GFR <15 mL/min/1.73 m2 or dialysis) Complications- Anemia – hemoglobin levels drop and not enough oxygen reaches many parts of the body. Central nervous system damage. Dry skin, skin color changes. Fluid retention – this can lead to swollen tissue, heart failure, and fluid build-up in the lungs. Hyperkalemia– blood potassium levels rise; this can result in heart damage. Insomnia – this is a common consequence of kidney failure Lower libido (sex drive) Male erectile dysfunction. Osteomalacia– bones become weak and break easily. Pericarditis – the sac-like membrane that envelops the heart (pericardium) becomes inflamed. Stomach ulcers. Weak immune system– the patient becomes much more susceptible to infection. Complications in children: Erythropoietinproduction drops, resulting in a much lower red blood cell count. Vitamin D – the kidneys will no longer be able to activate vitamin D, resulting in poor calcium absorption and muscle function. Consequently, children with kidney failure may fail to grow properly. Complications during pregnancy: When a woman is pregnant the kidneys have to work especially hard because the amount of fluid in the body increases. Pregnant women with chronic kidney failure may experience worsening hypertension and an increase in waste products in their blood. This can affect both the mother and her baby. Women with chronic kidney failure who are pregnant have a significantly higher risk of developing preeclampsia, compared to other women – blood pressure rises dangerously high. If left untreated the result could be a brain hemorrhage, or hemorrhaging in the liver or kidneys – both potentially fatal for both mother and baby.

Case electric Burns, entry point scalp, post debridement status, plz comment on management

30 yrs male Pt both side subclavicle this type infection (fungle ) from 2 month give tab.terbiforce 250 mg od × 5 weeks, Oint panderm plus cream. , candid lotion and tab cetzin HS but not cure lesions. .After stop local application increase lesions plz DX and Rx

35 Yrs M hospitalised for Alcoholic Acute Gastritis Non -Htn/ Non-DM No any Cardiac Symptoms PR 50bpm BP.. Normal ECG as follows How to approach??

43 y male On ATT since 9 months Brought to er with c/o breathing difficulty since theee days and fever . BP -120/90 on norad 15 ml per hour Temp - 98.3 f Urine output decreased Correlate ecg and abg with CXR and advice further treatment