Typical case

Typical case

The day before, the reporter was invited to the Beijing Chaoyang Diabetes hospital. Just stepped into the outpatient hall, happened to encounter an acquaintance of the hospital's hemodialysis center director dr.. Thus, the reporter asked to go back door, would like to visit the blood through the center. She agreed to the reporter's request, but there is an additional condition: must wear special white. Replace the white clothes, into the quiet, clean hemodialysis room, the reporter had a doctor addiction. There are 6 indoor dialysis dialysis machines, 6 patients on dialysis lying side by side, because of the inconvenient disturb, reporters will open the medical records of a patient's consent excerpts:

Patient: Zhou Mou, female, 46 years old, primary school teacher, Shandong.

Diagnosis: type 2 diabetes mellitus, diabetic nephropathy, uremia.

Chief complaint: type 2 diabetes for more than 5 years, 3 months of persistent systemic edema.

Current medical history: 5 years ago, the patient in the local blood glucose (fasting) 10.9mmol/L, diagnosed with type 2 diabetes. In 5 years, not regular use of Xiaoke pill, metformin, acarbose and other drugs, blood glucose control is not satisfactory, on larger fluctuations. 3 months ago in the "cold" after systemic edema, and dyspnea, abdominal distension, abdominal varices and other symptoms, check 24 hours urinary albumin excretion was 2.5 g / 24 hours, further check renal function, serum creatinine 1113 mol / L urea nitrogen, 25. 0mmol/L, diagnosed as type 2 diabetes mellitus, diabetic nephropathy, uremia. Subcutaneous injection of insulin to control blood sugar, combined with traditional Chinese medicine to reduce creatinine, urea nitrogen and other measures for treatment. In the maintenance of the treatment after 20 days, the effect is still not ideal, no systemic edema significantly reduced, for further treatment to come to treatment, outpatient with type 2 diabetes, diabetic nephropathy, uremia and admitted in the hospital, after admission examination, a temperature of 36.5 DEG C, the blood pressure of 160/95 mmHg, development of normal, medium, nutritional anemia, systemic edema; laboratory examination: blood creatinine 1193 mol / L urea nitrogen, 26.0mmol/L, hemoglobin 60 g / L, 24 hours urinary albumin excretion of 2.4 G /24 hours and received intensive insulin therapy, hemodialysis 3 times / week, and with the use of antihypertensive drugs such as swelling, anemia, symptomatic treatment, 18 days of hospitalization, the patient better than before, in 580 mol / L serum creatinine, urea nitrogen, hemoglobin 12mmol/L 80 g / L and 24 hours urinary albumin excretion of 1.5 g / h, systemic edema gradually disappear Back, blood pressure, blood glucose control basically stable.

Out of the dialysis center, the reporter went to the clinic in patients with diabetic nephropathy, a (male, 53 years old, 8 year history of diabetes, Hebei) told reporters: "every day I also adhere to the oral hypoglycemic drugs, diet and exercise therapy, but the blood glucose control is still not very good at the local hospital laboratory, fasting blood glucose 7.4mmol/L. Postprandial blood glucose 10.4mmol/L, HbA1c8.0% urinary albumin, 83 mg / L (normal value is less than 22 mg / L). Local doctors diagnosed early diabetic nephropathy." Then he said: "a month to come here and take gliquidon 1 tablets each time, three times a day before meals, glucoby 1 tablets each time, three times a day meal chewing, and adjust the diet and exercise regimen. After 30 days of fasting blood glucose 5.4mmol/L, postprandial blood glucose 6.9mmol/L, glycosylated hemoglobin decreased to 6.5%, urinary albumin of 18 mg / L, the condition has improved."

 

pre:Patient: Liu Xiang
next:Cases of chronic kidney disease

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