DUTY TEAM Dr. Fitriani Kemalina Dr. Rahmilna Dr. Yoga Vesri Dr. Riry Febrina Ersha Dr.

Rinni Andriani Dr. Guptaja Kusumah Nagara Dr. Linda Ratna Juita Dr. Fahrul

1.Supratman,male,58 yo The patient hospitalized day 3, WD: CKD stage V cb PNC with uremic bleeding + acidosis metabolic. Lab: Hb : 6,9 g/dl Ht : 22 % Tromb: 237.000/mm3 Leu : 8600/mm3 Na/K /Cl : 126/6,9/101 RBG : 107 mg/dl Ur/Cr : 517/42,2 BGA I : PH : 7,24 PCo2 : 18 PO2 :90 HCO3- : 7,5 BE :-20,1 SO2 :95

Thy: -Rest/ Flow NGT/fasting 8 h low protein 56gr low salt II - IVFD Easprimer:NaCl 0,9 = 2:1 500cc /12 hour - Ceftriaxone inj 2 x 1 gr -Lasix inj.1x1 amp - Folic acid 1x15 mg -Bicnat 3 x 500 mg - Transamin 3 x 1 amp - Vit K 3 x 500 mg - bicnat3 x 500 mg -inj.ca gluconas 1 amp extra - Transfusion PRC untill Hb 10 mg/dl Correction meylon250 meq into 250 cc NaCl 0,9 % quick drip - Liquid Balanced

Consultant Nephrology Assesment: CKD stage V cb Nephrosclerotic Hypertension

Condition when reffered, s/ Decrease of conciousness (+) Black defecation (+) Black vomite (+) O/ Bad, cons: apathy, Bp: 140/90 mmHg HR: 78 RR: 26 T: 37C Eye : anemic (+/+), Sclera Icteric (-/-) Lung : Vesicular Rales: -/- whz-/Cor : Cardiomegali (-) Abd : Liver and spleen unpapable. Ext : Oedem +/+ RF: +/+ Rp-/-

Lab: HB: 7,8 mg/dl BGA: PH : 7,24 HT: 23 % PCO2:18 Leu : 9060 /mm3 PO2 : 90 Tromb: 162.000/mm3 HCO3-: 7,5 Na/K/Cl: 146/5,1/107 BE :-20,3 Ur/Cre : 371/ 38,5 SO2 : 95%

Transfusion PRC post lasix Meylon correction Intensive controll Liquid Balanced

20.00 S/ Decrease of conciousness (+) Breathlesness (+) Black Defecation (-) Black vomite (-) O/ G: bad Cons:somnolen BP: 130/80mmHg HR: RR:28 T :37C
BGA: PH : 7,28 BE: -2,1 PCo2 : 12 SO2 : 88% PO2 : 63 HCO3- : 5,6 Assesment: Acidosis metabolic + Hypoxia Meylon correction RM mask 10 L/hour

22.00 PM S/Decrease of conciousness (+) Breathlesness(+) G: bad Cons: Somn BP: 130/90 HR: 90 RR: 26 T: 36,5C

24.00 S/Decrease of conciousness (+) Breathlesness(+) G: bad Cons: Somn BP: 130/70 HR: 91 RR: 27 T: 37,1C

01.00 S/Decrease of conciousness (+) Breathlesness(+) G: bad Cons: Somn BP: 130/70 HR: 92 RR: 27 T: 37,1C
01.30 AM Patient apneu BP unmeasured HR unpapable COD: Uremic Enchephalopati