Clinical medicine (London, England)
-
Around 3 million people in the UK have chronic kidney disease and 20% of hospital admissions are complicated by acute kidney injury. Decline in kidney function is not a diagnosis; it is essential to identify and treat underlying causes of acute and chronic kidney disease to either achieve recovery or slow the decline of kidney function. ⋯ The procedure is invasive and not without risk, which although small has the potential to be both organ- and life-threatening. This review outlines roles of kidney biopsy for the non-specialist, with focus of its role in patients with diabetes, lupus, myeloma and in the older patient.
-
Leptospirosis is one of the most important zoonotic bacterial diseases worldwide, commonly affecting resource-poor populations and resulting in significant morbidity and mortality. This article provides an overview of the epidemiology, clinical manifestations, diagnosis and treatment of human leptospirosis.
-
People with diabetes are more likely to require surgical intervention than those without and have an increased risk of developing postoperative complications. The Highs and lows review from the National Confidential Enquiry into Patient Outcome and Death reported on inadequate diabetes care in the perioperative period. ⋯ The plan will include dose adjustments of diabetes medication, and use of variable rate insulin infusion or continuous subcutaneous insulin infusion where applicable. The guideline also highlights the importance of improved communication between healthcare teams involved in the perioperative pathway in order to improve outcomes and care.
-
Review Case Reports
Hyperosmolar hyperglycaemic state as a stroke cause or stroke mimic: an illustrative case and review of literature.
Hyperosmolar hyperglycaemic state (HHS) is a life-threatening metabolic complication of type 2 diabetes (T2DM) that often presents with neurological symptoms. A 74-year-old man with known T2DM presented to the emergency department with collapse, left-sided weakness and slurred speech (National Institutes of Health Stroke Scale (NIHSS) 3) and a biochemical profile consistent with HHS. When he further deteriorated (NIHSS 20), he was managed for concurrent ischaemic stroke. ⋯ Two further cases of HHS mimicking ischaemic stroke have been reported with symptoms and imaging findings resolving with treatment of HHS. Our case demonstrates how HHS can also accentuate symptoms of a minor stroke, highlighting the importance of excluding ischaemic stroke in HHS patients with neurological dysfunction. We recommend consideration of early MRI and/or computed tomography angiography in this cohort, especially in those appropriate for intervention.