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【Weekly Medical Questions】is a new online column of "NEJM Medical Frontiers"
.
This column is based on NEJM Knowledge+, a sister product of the New England Journal of Medicine.
It pushes a question every Wednesday and announces the answers and detailed explanations on the next day
.
The questions and content seem simple, but they are the core knowledge points and error-prone points of clinical practice; correct answers are not the goal, mastering the main points is the kingly way
.
Ask the doctor every week to help you draw up the key points and save you time! Everyone is welcome to leave a message in the comments section
.
Your valuable comments and suggestions will be our best help! A 63-year-old male presented to the emergency department due to physical weakness, low-grade fever and fatigue for 1 week
.
The patient suffers from hypertension, type 2 diabetes, chronic obstructive pulmonary disease, chronic low back pain, and chronic hepatitis C virus infection with decompensated liver cirrhosis
.
The patient denied abdominal pain, vomiting, diarrhea, black or bloody stools, but decreased urine output
.
The patient is currently taking spironolactone (100 mg, once a day), furosemide (40 mg, once a day), a daily injection of 12 U of insulin degludec, and occasionally taking acetaminophen for back pain
.
The patient did not use opioids or non-steroidal anti-inflammatory drugs
.
Physical examination: The patient is generally in good condition and no acute symptoms are seen
.
Body temperature is 37.
4℃, heart rate is 94 beats/min, blood pressure is 90/53 mmHg, breathing is 16 beats/min, blood oxygen saturation is 96% when breathing ambient air
.
The patient has moderate ascites, multiple spider moles on the chest, and mild flapping tremor
.
The laboratory test results are as follows: A week ago, the patient's blood urea nitrogen level was 12 mg/dL, and the creatinine level was 1.
2 mg/dL
.
Urinalysis and microscopic examination of urine sediment showed that red blood cells, white blood cells, protein, white blood cell esterase, nitrite and cast were all negative
.
The urine sodium level is 5 mEq/L (the reference range varies with the amount of water consumed)
.
The doctor gave the patient an infusion of 1000 mL of normal saline, and performed a diagnostic abdominal puncture, and aspirated 50 mL of transparent grass-green liquid
.
Ascites test results showed that the neutrophil count was 700/mm3
.
The patient started receiving intravenous infusion of ceftriaxone and albumin for spontaneous bacterial peritonitis and was admitted to the hospital
.
The aforementioned drug treatment was continued after admission
.
The patient stopped taking daily oral diuretics and continued intravenous albumin infusion on the second day of admission
.
After 48 hours, the patient's renal function did not improve
.
In addition to continuing to use albumin, which of the following measures is best for treating this patient's acute kidney injury? A.
Start with intravenous furosemide.
B.
Recommendation for kidney biopsy.
C.
Start with midodrine and octreotide.
D.
Recommendation for renal replacement therapy.
E.
Excessive ascites.
The answer to the question is actually hidden in the question stem and abstract
.
Do you have the answer? If you are not sure, you can share the content with your friends, and the discussion can make people think more clearly
.
While answering the questions, please leave a message with your answers and diagnosis and treatment ideas to us
.
The answer will be announced tomorrow, we will see or leave! Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM)
.
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group
.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities
.
.
This column is based on NEJM Knowledge+, a sister product of the New England Journal of Medicine.
It pushes a question every Wednesday and announces the answers and detailed explanations on the next day
.
The questions and content seem simple, but they are the core knowledge points and error-prone points of clinical practice; correct answers are not the goal, mastering the main points is the kingly way
.
Ask the doctor every week to help you draw up the key points and save you time! Everyone is welcome to leave a message in the comments section
.
Your valuable comments and suggestions will be our best help! A 63-year-old male presented to the emergency department due to physical weakness, low-grade fever and fatigue for 1 week
.
The patient suffers from hypertension, type 2 diabetes, chronic obstructive pulmonary disease, chronic low back pain, and chronic hepatitis C virus infection with decompensated liver cirrhosis
.
The patient denied abdominal pain, vomiting, diarrhea, black or bloody stools, but decreased urine output
.
The patient is currently taking spironolactone (100 mg, once a day), furosemide (40 mg, once a day), a daily injection of 12 U of insulin degludec, and occasionally taking acetaminophen for back pain
.
The patient did not use opioids or non-steroidal anti-inflammatory drugs
.
Physical examination: The patient is generally in good condition and no acute symptoms are seen
.
Body temperature is 37.
4℃, heart rate is 94 beats/min, blood pressure is 90/53 mmHg, breathing is 16 beats/min, blood oxygen saturation is 96% when breathing ambient air
.
The patient has moderate ascites, multiple spider moles on the chest, and mild flapping tremor
.
The laboratory test results are as follows: A week ago, the patient's blood urea nitrogen level was 12 mg/dL, and the creatinine level was 1.
2 mg/dL
.
Urinalysis and microscopic examination of urine sediment showed that red blood cells, white blood cells, protein, white blood cell esterase, nitrite and cast were all negative
.
The urine sodium level is 5 mEq/L (the reference range varies with the amount of water consumed)
.
The doctor gave the patient an infusion of 1000 mL of normal saline, and performed a diagnostic abdominal puncture, and aspirated 50 mL of transparent grass-green liquid
.
Ascites test results showed that the neutrophil count was 700/mm3
.
The patient started receiving intravenous infusion of ceftriaxone and albumin for spontaneous bacterial peritonitis and was admitted to the hospital
.
The aforementioned drug treatment was continued after admission
.
The patient stopped taking daily oral diuretics and continued intravenous albumin infusion on the second day of admission
.
After 48 hours, the patient's renal function did not improve
.
In addition to continuing to use albumin, which of the following measures is best for treating this patient's acute kidney injury? A.
Start with intravenous furosemide.
B.
Recommendation for kidney biopsy.
C.
Start with midodrine and octreotide.
D.
Recommendation for renal replacement therapy.
E.
Excessive ascites.
The answer to the question is actually hidden in the question stem and abstract
.
Do you have the answer? If you are not sure, you can share the content with your friends, and the discussion can make people think more clearly
.
While answering the questions, please leave a message with your answers and diagnosis and treatment ideas to us
.
The answer will be announced tomorrow, we will see or leave! Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM)
.
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group
.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities
.