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Go Away, Kidneys!

Posted Sep 14 2009 2:24pm
Kidneys.

The vital organs in your body that helps to get ride of our daily toxins. When the kidneys stop working, the human body struggles to function properly. In certain cases, in which, the kidney becomes dysfunctional, dialysis may or may not be deemed appropriate.


I never liked renal medicine as a student. I found it all so complicated. I could not get my head around which part of the nephron absorbs or excretes what. (Yeap...I am still confused!)

My first day weekend on-call was about 1 week ago. I was given the task of covering the Renal Unit. Oh how exciting....NOT! I hardly have any experience in renal medicine as a SHO....the only experience I had was when I was a junior house officer. At that time, all I had to do was to do the paperwork when admitting patients, perform ECGs or blood tests, and treat patients with high potassium levels in their body.

I have to admit I was pretty intimidated by the on-call itself. The day didnt start too badly...but as the time passed by, things started to go haywire.

Renal patients are chronically ill. They always seem to be unwell either DURING or AFTER dialysis. Why is it so? I still haven't found the answer. They seem to have extremely difficult veins for cannulation. I recalled spending at least 30 minutes just trying to find a suitable vein for IV access.

All of the sudden, there were 3 people kicking off in the ward. One was having his/her dialysis, the other 2 were patients post-dialysis. All scoring a EWS* of 5-7!!

I did not know where to start. I decided to go to the patient with the highest score. This person apparently just finished dialysis, and became "funny." Yeap, it doesnt get any more specific than that. To be honest, I didn't understand what the nurses meant by the word "funny"....so I decided to assess the patient myself. He was semi-conscious, speech kinda slurred, breathing really fast. I went through a few differentials, and came to the conclusion that he was profoundly septic.

The other patient had 5Litres of fluid removed from his body...and, surprise, surprise, he was profoundly hypotensive!

The last patient who was unwell during his dialysis had an "unresponsive" episode, which recovered after 5 minutes.

The weekend just kinda went into such trend. A few sickies at the same time. I guess it has given me good learning opportunities in managing ill patients. But I still do not like renal medicine.
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