mg 8 mg X Cr 9.84 mg/ dl K 1.5 meq/l CK 24,570 U/L Mb 79,530 ng/ml Mb 230,000 ng/ ml AKI 2 IHD IHD 4 IHD

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ゆみかにばし
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1 mg 8 mg X Cr 9.84 mg/ dl K 1.5 meq/l CK 24,570 U/L Mb 79,530 ng/ml Mb 230,000 ng/ ml AKI 2 IHD IHD 4 IHD AKI HD Acute Kidney Injury AKI 48 Cr 0.3 mg/dl Cr ml/kg/ AKI 1,2 ATN CK Mb Mb AKI AKI

2 mg 8 mg X cm 35.8 kg BMI 13 kg/m 2 89/53 mmhg 66 / 36.5 SpO 2 96 room air 1 LDH BUN mg/dl Cr 9.84 mg/dl Ca 6.2 mg/dl Na 129 meq/ L K 1.5 meq/l UA 15.7 mg/ dl P 9.8 mg/dl CK 24,570 U/L Mb 79,530 ng/ml Mb 230,000 ng/ ml ph5.5 Cr mg/dl Na 63 meq/l K 10 meq/l Cl 49 meq/l NAG 1

3 U/L β2mg 6,783 ng/ml, Alb 857 mg/l bpm V2-V5 ST U 6 mm ph pco mmhg po mmhg HCO mmol/l anion gap 16.8 meq/l lactate 4 mg/dl CT FT31.06 pg/ml, FT ng/ml, TSH μiu/ml TPO ml/h ml/ h 20 meq/h 6 10 meq/ h 3,000 ml 100 ml/90 AKI 2 IHD 10 4 IHD NF1-1.6H 2 FB-110U 150 ml/ 3 2,100 2,500 ml HD egfr 25.2 ml/min/1.73m 2 U-TP 0.78 g/g Cr U-B2MG 23,085 ng/ml fractional excretion of K FEK egfr 30 ml/min/1.73m 2 U-TP 0.47 g/g Cr U-B2MG 16,485 ng/ ml 6 ST U ABPC/TAZ 1.5 g/day 25 mm 54

4 18 K 1.5 meq/ L X AKI 6,7 ACTH SS-A SS-B 15.1 ng/ml/h 177 pg/ ml PAC/PRA 12 ACTH pg/ml meq/l FEK ,9 Mb CK AKI Mb CK 10 ACC/AHA/NHLBI American College of Cardiology/American Heart Association/National Heart, Lung and Blood Institute CK AKI CK CK 5,000 U/L AKI 12 Peak CK 15,000 20,000 U/L AKI 4 Peak CK 16,000 U/L RRT prediction score 14 AKI

5 19 2 RRT 17.8 kda β2-microglobin 11.8 kda high-flux 0.8 super high flux 15 NF- 1.6H 2 FB-110U AKI RRT 16 AKI RRT 2 1 Liaño F, Pascual J: Epidemiology of acute renal failure: a prospective, multicenter, communitybased study. Madrid Acute Renal Failure Study Group. Kidney Int, 50(3): , Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al.: Program to Improve Care in Acute Renal Disease: Spectrum of acute renal failure in the intensive care unit:the PICARD experience. Kidney Int, 66(4): , (4): , 2014.

6 20 4 Bosch X, Poch E, Grau JM: Rhabdomyolysis and acute kidney injury. N Engl J Med, 361: 62 72, Zimmerman JL, Shen MC: Rhabdomyolysis. CHEST, 144(3): , , Knochel JP, Schilen EM: On the mechanism of rhabdomyolysis in potassium depletion. J Clin Invest, 51: , Merante A, Gareri P, Marigliano NM, De Fazio S, Bonacci E, Torchia C, et al.: Laxative-induced rhabdomyolysis. Clin Interv Aging, 5: 71 73, Saglam O, Filik L: A case of sodium picosulphateinduced rhabdomyolysis. Acta Clin Belg, 70(4): 307, Giannoglou GD, Chatzizisis YS, Misirli G: The syndrome of Rhabdomyolysis: Pathophysiology and diagnosis. Eur J Intern Med, 18: , Pasternak RC, Smith SC, Jr. Bairey-Merz CN, et al.: ACC/AHA/NHLBI Clinical Advisory on the Use and Safety of Statins. Circuration, 106: , Brown CV, Rhee P, Chan L, et al.: Preventing renal failure in patient rhabdomyolysis: do bicarbonate and mannitol make adifference? J Tauma, 56: , Ward MM: Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med, 148: , McMahon GM, Zeng X, Waikar SS: A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med, 173(19): , Naka T, et al.: Myoglobin clearance by super highflux hemofiltration in a case of severe rhabdomyolysis: a case report. Crit Care, 9: R90 95, Petejova N, Martinek A: Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Crit Care, 18(3): 224, 2014.

sick contact1l

Clinical Question 2017 年 5 月 15 日分野 : 内分泌テーマ : 治療 19 14 15 18 sick contact1l 170cm/68.8kg, GCSE1V1M5, HR: 120/min, BP: 104/60mmHg, RR: 30/min, SpO 2 : 96%, BT: 38.0 WBC Hb PLT CRP Cr BUN 23400 15.0 35.5