55 k Aravindh

  1.indications for dialysis ?       1.plasma urea >180mg/dl        2.hyperkalemaia >6mmol/l       3.metabolic acidosis       4.fluid overload and pulmonary edema        5.Uremic encephalopathy        6.creatinine levels >6.8.g/dl 2.why patient not recovering from sedation since 2 days?   1.normally metabolites of midazolam eliminated by kidneys.but in this patient kindney functions are impaired,because of impaired elimination prolonged action is seen.sedation also prolonged.    2.midazolam administration along with atorvastatin results in delaying elimination.so midazolam administration along with atorvastatin is not recommended. LEARNING POINTS;    1.i have learned about importance of clinicals along with theory . 2.l have learned about types of heart failure,clincal features, management of heart failure. 3.importance of contraindications and drug interaction while prescribing medications. 4.imporatance of control of comorbidities.

 K Aravind,roll no 55,9th sem.    This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment.  A 67 year old Male R/O Devarakonda , came to the casualty 5days back with complaints of Shortness of breath since 10 days and pedal & facial edema since 8 days.  History of presenting illness; Patient was apparently asymptomatic 10 days back , then he developed Shortness of breath which is insidious in onset, gradually progressive in nature, aggravating on exertion and relieved on taking rest, progressed from grade II to grade III- IV (Modified MRC