MEDIC ILMU

 1 - STATUS EPILEPTICUS

- If  more than 5 minit duration

- if after 1st dose Supp Valium ---> give iv Valium ( iv diazepam )

**for adult

- after 5-10  mins 

= FIRST LINE THERAPY - iv LORAZEPAM 2-4 mg at 2mg/min  OR iv DIAZEPAM  0.2 mg/kg (usually 5-10 mg) at 5mg/min  and REPEAT IF  seizures NOT STOP AFTER 5 MINS

- IF no iv line , give PR DIAZEPAM  20 mg 

then,

- after 10-30 mins

= SECOND LINE THERAPY - loading dose iv PHENYTOIN 15-20mg/kg at <50mg/min 

(additional dose 5-10 mg/kg phenytoin if seizure continue

OR

iv SODIUM VALPROATE 20-40mg/kg over 10 min and additional dose 20mg/kg  over 5 mins if seizure continue

2- HYPOCALCAEMIA

- long term treatment : Calcium carbonate 800-2000 mg elemental calcium/day in divided dose

*calcium carbonate - ambil dengan makanan

*calcium citrate - can with or w/out food

3- SEPSIS

- qSOFA criteria at least 2 may indicate sepsis : 1) altered mental status,gcs <15..... 2) SBP <100....3) respi rate >22

4- CKD CPG 2018 KEY POINTS ( TAKE HOME MESEJ )

- Risk factors for Chronic Kidney Disease: drugs e.g. nephrotoxic drugs, long-term use of proton-pump inhibitors or analgesics + gout + hypertension • age >65 years old • obesity • cardiovascular disease • metabolic syndrome

- . Drugs There is conflicting evidence in the association between chronic non-steroidal anti-inflammatory drugs (NSAIDs), aspirin and paracetamol usage and the development of CKD.9 However, among the most common risk factors for acute decline in GFR for patients with established CKD is NSAIDs, including cyclooxygenase-2 inhibitors.12 Use of proton pump inhibitors (PPI) has been shown to significantly increase the risk of developing CKD (RR/OR range of 1.10 to 1.50)

- Certain herbal products including those containing aristolochic acid are associated with CKD

- Other possible risk factors include autoimmune disease, nephrolithiasis, structural renal tract disease, prostatic hypertrophy, low birth weight of <2,500 g, smoking, low socioeconomic status, anaemia, nocturia and physical inactivity

- Haematuria Persistence microscopic haematuria may indicate significant pathology such as infection, glomerulonephritis, renal calculi, malignancy and other forms of kidney damage. A positive dipstick test for blood on two out of three occasions warrant a full microscopic examination.

- Renal Ultrasound Ultrasound is a useful first-line test for renal tract imaging. It provides information on: • renal size and symmetry • cortical thickness and echogenicity • urinary tract obstruction • solid or cystic lesions

- General indications for renal ultrasound:9 ○ rapid deterioration of renal function (loss of eGFR >5 ml/min/1.73 m2 within one year or 10 ml/min/1.73 m2 within five years) ○ haematuria ○ symptoms or history of urinary tract obstruction ○ family history of polycystic kidney disease and age over 20 years ○ when a renal biopsy is indicated

- The current classification of CKD is based on KDIGO 2012 guidelines which has health and prognostic implications.12 • CKD is defined as: ○ eGFR <60 ml/min/1.73 m2 that is present >3 months with or without evidence of kidney damage* OR ○ evidence of kidney damage* that is present >3 months with or without eGFR <60 ml/min/1.73 m2

- *Markers of kidney damage are: a. albuminuria (AER ≥30 mg/24 hours or ACR ≥3 mg/mmol) b. urine sediment abnormalities c. electrolyte and other abnormalities due to tubular disorders d. abnormalities detected by histology e. structural abnormalities detected by imaging f. history of kidney transplantation

- Blood pressure target for chronic kidney disease - ≤130/80 mmHg

- Protein restriction is one of the supportive measures to delay CKD progression. Low protein diet of 0.8 g/kg/day is recommended in DKD vs 0.6 - 0.8 g/kg/day in non-DKD

- There is emerging evidence to suggest uric acid reduction is a potential strategy to delay CKD progression. However, more RCTs are needed to confirm the renoprotective effect. One meta-analysis which included publications of all languages reported that uric acid reduction mainly by allopurinol led to higher eGFR and lower SCr compared with control in CKD