QuestionSBA
QuestionChoice
As there is evidence of nephropathy in this patient, she should be started on a renoprotective agent pending a repeat urine dip and/or confirmation of end-organ damage
34065
a
Start lisinopril 2.5mg PO OD
QuestionChoice
Without a blood sugar diary to monitor for labile BMs, it is inadvisable to make changes to a patient’s daily insulin regimen
34069
e
Switch her insulin regime to a biphasic preparation e.g 30% insulin lispro/70% insulin aspart (Novomix 30)
QuestionChoice
As the patient’s TSH level is normal and she is not complaining of any symptoms indicative of undertreating her hypothyroidism, this is not a necessary course of action
34066
b
Increase dose of levothyroxine sodium to 150 micrograms PO OD
QuestionChoice
Without a blood sugar diary to monitor for labile BMs, it is inadvisable to make changes to a patient’s daily insulin regimen
34067
c
Increase nightly insulin detemir to 20 units
QuestionChoice
This is an unlicensed treatment for vitiligo and may be prescribed off-label by experienced clinicians
34068
d
Start tacrolimus 0.1% ointment topical BD
QuestionComment
ACE inhibitors are nephrotoxic, why is lisinopril renoprotective?
60842
QuestionComment
they're nephrotoxic in an AKI but protective in CKD because they do something good to the blood flow in the glomerulus 
61452
User
subscriber
Epidermis Benign
QuestionComment
essentially they forcibly reduce glomerular pressure. helps with hypertension or with glomerular sclerosis, but once u have AKI and u can't compensate, it means ur pressure is *too* low and u gotta stop the ACEI's to maintain a normal filtration pressure
61857
User
subscriber
Pseudopseudopseudopseudohypoparathyroidism
QuestionComment
essentially they forcibly reduce glomerular pressure. helps with hypertension or with glomerular sclerosis, but once u have AKI and u can't compensate, it means ur pressure is *too* low and u gotta stop the ACEI's to maintain a normal filtration pressure
61858
User
subscriber
Pseudopseudopseudopseudohypoparathyroidism
User
subscriber
Retake Prophylaxis 
QuestionComment
what are the signs of nephropathy here am I actually going insane

61860
QuestionComment
The proteinuria I think. Tricky :/
61896
User
subscriber
Cor Pulmonale
User
subscriber
Miabetes Dellitus
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2757
Diabetes with evidence of renal impairment
Topic
92
General Practice
6824
Case Presentation: A 39 year old woman attends her GP for a routine diabetic review. **PH** type 1 diabetes, hypothyroidism, Addison’s disease. **DH** soluble insulin (Humulin S) 10-12 units SC TDS with meals, insulin detemir (Levemir) 16 units SC ON, levothyroxine sodium 125 micrograms PO OD, hydrocortisone 20mg PO in the morning and 10mg PO in the evening. NKDA


**O/E**

HR 71, RR 11, BP 134/82, O2 100% RA, Temperature 36.6°C. HS I + II + 0. Chest clear. Vitiliginous patches on hands. Visual acuity and colour vision grossly normal.

**Investigations**

TSH: 1.2 (0.4-5.5)

HbA1c: 46 (target <48)

ECG: normal sinus rhythm

Urine dipstick:

Blood -ve

Nitrites -ve

Protein +1

Leucocytes -ve

A:Cr ratio: 3 mg/mmol

Question: Select the most appropriate management at this stage.
a