TREATMENT OF TUBERCULOSIS IN CHRONIC RENAL FAILURE PATIENTS

Treatment of tuberculosis in chronic renal failure patients is slightly different from that of a patient with normal renal function.Avoid aminglycosides.INH and rifampicin can be used in their usual doses as these drugs are excreted primarily in bile. Ethambutol should be used at dosage of 15mg/kg body wt three times weekly and pyrazinamide at dosage of 25mg/kg body wt three times weekly. the duration of treatment remains the same as for any tuberculosis patient

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AN UNUSUAL PRESENTATION OF RENAL FAILURE

A 75 year old man presented to the opd with the chief complaint of shortness of breath since last 2-3 months which worsened during last 3-4 days.There was no fever,cough,chest pain,swelling of body,bowel or bladder problems.On examination his bp was 160/80,pulse84/min,regular,respiratory rate was 24/min,no cyanosis, clubbing,pedal oedema.his chest was clear and heart sounds normal,abdominal examination did not reveal any abnormality.he was a non smoker,non alcoholic,ex tailor. His spo2 was 84% in room air.He was hospitalized for investigation and management.His chest xray and resting ECG was normal.The only abnormality in his blood reports was raised urea(200)and creatinine(13.6) values.He was suggested urgent haemodialysis to which he denied,left hospital and was lost to follow up.
CLINICAL PEARLS :
This was a case of acute renal failure ,probably in the background of chronic renal failure which was not detected earlier.So beware,shortness of breath may be the sole presenting feature of renal failure,in the absensce of any other signs or symptoms
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Heat can be dangerous for humans and can cause heat stroke leading to death

A fifty five year old man presented to our hospital with altered sensorium, tachypnoea, tachycardia and normal BP. There was history of lower limb weakness just half an hour before losing conciousness. His body temperature was 106 degree farenhiet, ECG was normal. There was no focal neurological defecit. He was diagnosed as heat stroke. Active cooling was started with ice water bath, IV fluids, cold saline gastric lavage. In the next fifteen minutes he started having massive haemoptysis. In the next ten minutes suddenly patient had a severe hypotension followed by cardio respitory arrest.

Cinilcal pearls:

Heat stroke may have a subtle presentation and when recognised it may be too late to salvage the patient. So in a tropical country like India when the outside temperature is very often more than 45 degrees centigrade in summer months, one needs to be very careful with proper hydration and avoid out door job as much as possible during this period.

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