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7/26/2019 Rta Case Protocol
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RECURRENT LOWER
EXTREMITY WEAKNESS
A CASE PRESENTATION
PRESENTOR
SALIP NASTRA AMING- JUMAANI MD,
MPH
SENIOR RESIDENT
NELSON LAJA, MD
CONSULTANT
MICHAEL ABUTAZIL MD, FPCP,DPSN
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AUGUST 17, 2010LUNCH TIME
Genera O!"e#$%&e'(
T) *re'en$ a #a'e )+ *).ae/%a 'e#)nar $) rena $!ar a#%)'%'
S*e#%#a a' $)(
13 Pa$)*'%))4 )+ *).ae/%a
23 La!)ra$)r %a4n)'$%#' )+ RTA
53 Trea$/en$ an *a$e' )n *).ae/%a
T%' %' a #a'e )+ An4e B)n44), 16 )F +r)/ Re#)) 8) 8a' !r)4$ $) $%'
%n'$%$$%)n 8%$ a #%e+ #)/*a%n$ )+ )8er e9$re/%$ 8ea.ne''3
One a *r%)r $) a/%''%)n, *a$%en$ e9*er%en#e a n/!ne'' an 8ea.ne''
'en'a$%)n )n !)$ %'$a e9$re/%$%e' 8%# 8a' 4raa *r)4re''%n43
M)rn%n4 *r%)r $) a/%''%)n, $ere 8a' a /ar.e *r)9%/a )8er e9$re/%$
8ea.ne'' a' #)/*are $) $e %'$a e9$re/%$%e'3
:%$ $e *er'%'$en#e )+ '/*$)/', 'e 8a' !r)4$ $) $%' %n'$%$$%)n an
8a' '!'e;en$ a/%$$e3
Pa$%en$ 8a' *re&%)' a/%$$e 8%$ $e 'a/e #)/*a%n$ )+ )8er e9$re/%$
8ea.ne''3 Se %' n)$ %a!e$%#, a'$/a$%#, *er$en'%&e 3Se a') )e'n<$
e9*er%en#e an #ar%a# %'ea'e3 Tere 8ere n) +a/%%a %'ea'e' !e%n4 %en$%e3
Se %' $e +)r$ #%, 8%$ n) &%#e' an aer4%e' $) an +)) an r4'3
Pa$%en$ en%e' an $ra/a *r%)r $) $e )n'e$ )+ )8er e9$re/%$ 8ea.ne''3
Tere 8a' n) +e&er, #)4 an %=#$ )+ !rea$%n43 Se % n)$ &)/%$> a
re4ar !)8e /)&e/en$ an r%nar #)n$%nen#e3
On *'%#a e9a/%na$%)n, *a$%en$ 8a' a8a.e, a+e!r%e an n)$ %n re'*%ra$)r
%'$re''3 Se a an an%#$er%# '#erae, *%n. *a*e!ra #)n"n#$%&ae 8%$ n) na'a
%'#ar4e' an #er&%#a /*aen)*a$%e'3 Se a a '//e$r%#a #e'$
e9*an'%)n 8%$ n) re$ra#$%)n, e;a $a#$%e an &)#a +re/%$' an 8%$ #ear !rea$
')n'3 Te *re#)r%/ 8a' ana/%# 8%$ a *)%n$ )+ /a9%/a %ne9 )#a$e a$ $e
?$ e+$ /%#a&%#ar '*a#e 8%$ a re4ar ra$e an r$/3 Tere 8ere n) /r/r'
a**re#%a$e3 Her a!)/en 8a' @a$, n)r/)a#$%&e, ')+$, n)n $ener 8%$ n) *a*a!e
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/a''3 Te e9$re/%$%e' 8ere 4r)'' n)r/a 8%$ n) !r%'e', e/a$)/a' )r !%*ea
ee/a3 Te *'e' 8ere + an !)n%n4 8%$ +)) #a*%ar re3 Re#$a
e9a/%na$%)n re&eae a 4)) '*%n#$er%# $)ne an + re#$a &a$3 H)8e&er, $e
/)$)r '$ren4$ )n !)$ )8er e9$re/%$%e' 8a' 5? a' #)/*are $) $e **er
e9$re/%$%e' 8%# 8a' ??3
Te *a$%en$ 8a' $en a/%$$e3 Ser/ *)$a''%/ 8a' re;e'$e an
re&eae *).ae/%a 137//)L3 CL r%* 8a' )).e a$ a ra$e a$ 10 /e;'r an
.a%/ re )ne $a!e$ 59 a a 8ere 4%&en3 Ur%na'%', 'er/ ')%/, #rea, ABG
an UB $ra')n a' 8e a' )n4 ea II e#4 8ere re;e'$e3
On $e 'e#)n )'*%$a a, re*ea$ 'er/ *)$a''%/ 8a' 232//), 'er/
#rea 8a' n)r/a a$ //)L, r%na'%' re&eae r%ne * a$ 3?, *r%a a$ -
12*+, e/a$r%a a$ 5-?3 Se 8a' '$ar$e 8%$ #%*r)@)9a#%n a$ 200/4$a! !%3 CL
r%* 8a' #)n$%ne a$ 10 /e;'r3 Ser/ ABG an UB UTZ 8ere +))8e *3
Ser/ #a#%/, /a4ne'%/, r%ne #rea$%n%ne an *)$a''%/ 8ere re;e'$e3 A$ $a$
$%/e, $e *a$%en$ #a%/e $) a&e an %/*r)&e/en$ )+ er )8er e9$re/%$ 8ea.ne''8%$ a /)$)r '$ren4$ )+ ?3
On er 5r )'*%$a a, $e *a$%en$ #an '$an * area 8%$ n) %=#$3
Ser/ ABG re&eae #)/*en'a$e /e$a!)%# a#%)'%'3 Te UB UTZ ')8e a
%'e rena *aren#/a %'ea'e )+ 4rae 1 an #'$%$%'3 Ser/ #a#%/ an
/a4ne'%/ 8ere n)r/a> r%ne #rea$%n%ne a$ 1116 /)L an r%ne *)$a''%/ )+
3? //)L3 T%' $%/e, $e *a$%en$ 8a' '$ar$e 8%$ *)$a''%/ #%$ra$e )+ 1 $a!e$ 59
a a3 Re*ea$ 'er/ *)a$a''%/ 8a' 5323 Pa$%en$ 8a' '!'e;en$ %'#ar4e 8%$
)/e /e%#a$%)n' )+ ( .a%/ re $a!e$ 59 a a +)r )ne a /)re > *)$a''%/
#%$ra$e )+ )ne $a!e$ 59 a a a' a /a%n$enan#e /e%#a$%)n an #%*r)@)9a#%n 2?0/4
29 a a +)r 2 a' /)re3
Final Impression( Rena T!ar A#%)'%' $*e 1
LABORATORY RESULTS
Serm K !"#$"#% !"&%"#% !"&#"#%
#'(mmol"L &'&mmol"L )'&mmol"L
Urinal*sis
C))r( %4$ e)8 P' #e'( -12*+
Tran'*aren#( '%4$ #) RBC( 5-?
Rea#$%)n( 3?
S*e#%# 4ra&%$( 13010
7/26/2019 Rta Case Protocol
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S4ar( ne4a$%&e
Pr)$e%n( 1
Ser/ Crea$%n%ne( /)L
Ser/ ')%/( 1?//)L
Ar+erial Bloo, -as
*H( 73260 735?- 73?
*CO2( 5?//H4 5?-?//H4
*O2( 10 //H4 0- 100//H4
HCO5( 130 //)L 22-2//)L
In$er*re$a$%)n( Me$a!)%# A#%)'%'- C)/*en'a$e
Serm Cal.im( 230 //) 231- 23??
Serm Ma/nesim ( 03 //)L 037- 130
Urine Crea+inine( 1116 /)L 7072- 1?612
Urine Po+assim( 3?//)L
KUB UT0
D%'e rena *aren#/a D%'ea'e, #'$%$%'
Si/ni1.an.e o2 +3e s+,*
Te %n#%en#e )+ *).ae/%a %' #)//)n %n )r )#a 'e$$%n43 T%' #a'e
*r)&%e ' $e /er%$ )+ e9*orin/ +3e e+iolo/ies o2 3*po4alemia an, +3e
approa.3 as +o 3o56 5e as a p3*si.ian6 respon, +o +3eir .omplain+s' T3e
re.rren.e o2 s*mp+oms s3ol, promp+ s +o in7es+i/a+e 2r+3er an, 8e
2amiliar 5i+3 +3e ,ia/nos+i.s nee,e, +o +rea+ Urinar* Tra.+ In2e.+ions in
or,er +o ren,er 9ali+* .are +o pa+ien+s'