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发帖数: 1 | 2 账户：albumin
版主好，上述账户不知为何被封，烦请解封 谢谢 |
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I****a
发帖数: 407 | 3 Interesting. I would like a UA, LFT including total protein and albumin. |
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a*******n
发帖数: 82 | 4 En, I gave her Ativan 0.5 mg once. Her nausea was unchanged.
Her vitals: afebril, HR 56, BP 105/68, RR 12, Sating 94% on 2 L NC.
Her UA showed >20 WBC, positive nitrites, positive LE and culture eventually
grew out E coli. LFT showed albumin 2.5, TP 4.6, otherwise unremarkable.
She had a million of things going on, however, I believed "nausea" is the
key. She didn't have any vertigo or dizziness or vision change, which made
CNS cause less likely. Gastritis? severe nausea without pain? Doesn't so... 阅读全帖 |
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I****a
发帖数: 407 | 5 Interesting. I would like a UA, LFT including total protein and albumin. |
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a*******n
发帖数: 82 | 6 En, I gave her Ativan 0.5 mg once. Her nausea was unchanged.
Her vitals: afebril, HR 56, BP 105/68, RR 12, Sating 94% on 2 L NC.
Her UA showed >20 WBC, positive nitrites, positive LE and culture eventually
grew out E coli. LFT showed albumin 2.5, TP 4.6, otherwise unremarkable.
She had a million of things going on, however, I believed "nausea" is the
key. She didn't have any vertigo or dizziness or vision change, which made
CNS cause less likely. Gastritis? severe nausea without pain? Doesn't so... 阅读全帖 |
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V*****G
发帖数: 337 | 7 I have to ask you some more questions about history, since you didn't
mention abd pain in the 1st post, now you said there is abd pain, this
potentially changed the whole picture.
I still need more info about history if you don't mind.
For history:
Abd Pain: OCDFPPLIQRAAA all needed
Diarrhea: OCDFPPAAA ABCO, blood?
Other GI symptoms: nausea, vomit, jaundice, abd bloating, if there is
constipation, relationship between constipation and diarrhea
Edema: OCDFPPAAA, esp aggravating and alleviati... 阅读全帖 |
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I****a
发帖数: 407 | 8 What issue is primary? What issues are secondary?
It is hard to pinpoint at this moment for me w/o knowing any lab values.
This is likely a systemic process with multiple organ system involvement: GI
, vascular and possible renal and heme. I would guess diagnosis is
eventually made by a pivotal biopsy.
How would you work her up?
I would focus on elucidating the cause of anasarca and hypokalemia,
specifically UA, urine protein/creatinin ratio, urine lytes to calculate
transtubular potassium gradi... 阅读全帖 |
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V*****G
发帖数: 337 | 9 Nice to see the lab.
Majority consistent to GI loss (malnutrition/malabsorption)
Edema is due to hypoalbumin and low protein. Originally lower extremity edema was thought to be due to systemic involvement. But when I saw "4+ pitting edema up to low back" on PE on day 2, I knew it could be due to low protein level. I appreciate the good PE you did. :)
Hypokalemia is most likely due to GI loss too.
Other lab abnormalities suggested:
Group 1: Low VitD, low phosphate, low calcium = Vit D deficienc... 阅读全帖 |
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A*******s
发帖数: 9638 | 10 【 以下文字转载自 Medicine 讨论区 】
发信人: beatnsc (beatnsc), 信区: Medicine
标 题: 求助！国内医生无法诊断哥哥病因，莫非中国医生水平就是不行？
发信站: BBS 未名空间站 (Fri Jul 29 01:04:40 2011, 美东)
我哥哥两个月前开始出现全身性水肿，尤其双腿水肿严重。他胸腔有很多积液，呼吸困
难。腹腔也有一些积液。检查出血液的白蛋白（ALBUMIN)很低，另外噬酸细胞（
eosinophil)很高。其他结果都正常。于是抽积液，打点滴补白蛋白。也有怀疑是寄生
虫，但是血液，尿，粪便都找不出寄生虫。症状缓解出院，可是过了俩个星期又是水肿
，胸腔积水。于是又进了另一个医院，查了2个星期，还是查不出原因。又换了第三个
医院（全市最好的医院），又查了两个星期，近百次大大小小的检查，最后全医院的医
生汇诊，只是给出两个猜想，要么是癌症病变，要么是结核菌（TB)感染。但是没有任
何检查结果可以确定是其中的任何一种。我哥哥十几年前曾有过大腿的骨髓炎，而且一
直是乙肝携带（小三阳）。他的身体一直不是非常好，很容易得感冒。但是这些似乎... 阅读全帖 |
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L*****r
发帖数: 722 | 11
one
人家在挖资本主义墙角掏鸟窝，您老在挖资本主义故纸堆淘胸水，到底是老大LOL。
真没想到Light's criteria 在1972就出来啦。那年头大约还没有sensitivity/
specificity/四格表的概念，所以后来人发现，按照Light's criteria，有25%的漏出
液会被误诊为渗出液。譬如说，用利尿剂后，漏出液里面的总蛋白就会上升到渗出液的
水平。本例患者既然输了白蛋白消肿，极有可能同时也给了速尿，所以他的胸水总蛋白
水平高，也可能用利尿剂来解释。我觉得不太对劲的，就是他的LDH 水平实在很低，比
你引的200 低多了，所以我觉得他也可能就是个漏出液，因为用了利尿剂，所以蛋白水
平表现为渗出液，也就是我前面说的假性渗出液。
要证明我的猜测，其实也简单，就是测胸水的白蛋白和胆固醇，
a serum to pleural fluid albumin gradient (the difference between the serum
and pleural values) greater than 1.2 g/dL (12 g/L)， and/or ple... 阅读全帖 |
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A*******s
发帖数: 9638 | 12 他提到的都是漏出液， 病人的蛋白很高，血albumin低， 所以ratio不可能低的。
啊？ |
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s******v
发帖数: 477 | 13 I admitted a patient 5 AM this morning. 40 AAF, c/o nausea vomiting and
extremely lethargic at home, found hypoglycemia glucose 35 by EMS.( nobody
has DM in the family, less likely she got any hypoglycemic agent ). She had
multiple similar episodes before. It always happened during her menstrual
period. Patient was found hypocalcemia since her 20s.
Ca 5.3, prolong QT 550 ms, Magnesium 2.1, albumin 3.7.Ultrasound found left
thyroid nodule, extensive bilateral basal ganglion calcification on head ... 阅读全帖 |
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y******a
发帖数: 590 | 14 how about other inflammatory markers, e.g. CRP, ESR, albumin, platelet, LDH?
are they also elevated? |
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r*******n
发帖数: 51 | 15 I am not sure whether CRP, ESR and LDH were ordered or not. Below are all
tests that were ordered and normal.
Albumin and platelet are normal.
Besides, Creatinine, Creatinine(Crcl), Estimated Glomerular Filteration Rate
- MDRD, Bilirubin Total, Alkaline Phosphatase, and Gama Glutamyl
Transferase are normal.
Iron, Iron saturation, B12, TSH, A1C, eGFR, Cholesterol, Triglycerides, HDL,
LDL, TC/HDL-C Ratio, and Potassium are normal.
Hemoglobin, Hematocrit, RBC, RBC indeces: MCV, MCH, MCHC, RDW, WBC,... 阅读全帖 |
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I****a
发帖数: 407 | 16 I have seen normal A1C in the case of mild anemia and high red cell turn
over state. I was told there is similar test based on measurement of
glycolated albumin which can help in such situation.
switched
could
formal |
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R*******t
发帖数: 367 | 17 那她的fatigue跟减肥一定会有关系，她的glucose tolerance test pre只有64，有点
低啊。营养不良，维生素不足，电解质失衡什么的。查查蛋白albumin什么的了吗？不过没有水肿，蛋白估计还可
以。
她吃维生素吗？有借助药物减肥吗？
weight |
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U********e
发帖数: 20 | 18 Morbid obese young female (BMI>45) with severe weeping pedal edema (3+
pitting edema) without cardio or pulmonary conditions.
Already start lasix 40mg po daily-----no improvement
Slightly anemia (Hgb: 10.2), albumin: 3.2
Not on any medication except new start Lasix
Not a good candidate for Ted hose due to her obesity.
Any other outpatient options? I need input from you guys! Thanks |
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b******a
发帖数: 704 | 19 ZZ: What is hepatitis B? — Hepatitis B is a serious disease that harms the
liver. The liver is a big organ in the upper right side of the belly. A
virus causes this disease. The virus spreads from person to person when
their bodily fluids touch. This can happen in a few ways, like having sex or
sharing needles.
It is estimated that there are more than 300 million carriers of the
hepatitis B virus in the world, with over 500,000 dying annually from
hepatitis B-related liver disease. In China, HB... 阅读全帖 |
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a*********d
发帖数: 2763 | 20 case 3
A 30-year-old man sees his primary care physician for routine follow-up and
is documented to have a serum calcium concentration of 12.9 mg/dL. He is
admitted to the hospital directly from the clinic for further evaluation and
treatment. The patient states that he has a 5-year history of sarcoidosis,
but admits to nonadherence to his follow-up care and treatment regimen. He
had 1 episode of nephrolithiasis approximately 1 year ago and was told that
his kidneys are “abnormal.” Before admiss... 阅读全帖 |
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f**********r
发帖数: 76 | 21 病情如下:
"姑姑在上海对右输尿管中部外側肿瘤进行伽玛刀(γ)治疗(实质上是放疗) 于 5月31日
结束后,6月28日小便出现尿血,按常规止血方法均告无效。后上海专家用介入法,在大腿
根部微创一个米粒大的口子,用动脉造影的方法去找出血点,发现膀胱壁上有一片渗血处
,用了血管收缩剂,效果甚微。姑姑现住在医院里，每天靠输血（300-450ml）和人血白
蛋白（Human Albumin）维持。由于失血多，不能下床行走，只能躺在床上大小便，浮
肿，肌肉萎缩，腿自己不能抬，小便的颜色很红，还伴有血块(B超显示膀胱里有血块)"
非常感谢! |
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h*******r
发帖数: 182 | 22 家人过去一年不到受肝功能异常困扰，特来向各位专家求教， 究竟要不要做肝穿刺活
检。 多谢了！
年龄:
72
性别:
女
症状:
No significant signs and symptoms, no abdominal pain, no jaundice, no
diarrhea, normal appetite with regular diet.
病史:
Two episodes of fever (~39 C) lasting less than a week 10 months ago, no
cough, no diarrhea or vomiting. Test showed elevated LFT with AST/ALT ~400-
500 U. Viral profile showed negative for HAV, HBV, HCV and HEV. No
autoimmune antibodies. Total cholesterol 270 mg/dL, triglyceride 140mg/dL.
Glucose normal. After thre... 阅读全帖 |
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B******f
发帖数: 2489 | 23 见到这个case很久了，一直想post上来分享，觉得A＋＋和小粉可能会喜欢，嘿嘿
20+ yo F
HPI: multiple episodes of altered mental status (AMS), shortness of breath,
slowed speech since 8 months ago. An episode can last days, and she returns
to base line function between episodes. During the periods of AMS, patient
was unable to care for herself, and the mother had to dress and feed her.
PMH: she had multiple hospital admissions to outside Hospital for similar
complaint, however, work up has been negative
Head CT: Normal
Brain MRI: No... 阅读全帖 |
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o******e
发帖数: 1761 | 24 不知道他们的具体身份，职业。 有没有这一行的朋友说说的？
http://kmuw.org/post/two-chinese-scientist-try-steal-rice-ks-re
Two Chinese Scientist Try To Steal Rice From KS Research Facility
Two crop scientists from China are accused of trying to steal rice seed
samples from a biopharmaceutical research facility in Kansas. Federal
charges have been filed against the two men in U.S. District Court, in
Kansas City, Kansas.
47-year-old Weiqiang Zhang and 63-year-old Wengui Yan are charged with
conspiracy to steal trade secrets. T... 阅读全帖 |
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p****y
发帖数: 23737 | 25 http://www.twvns.org/articles/research/16-2008-07-31-09-43-31
许多研究已经證实饮食对糖尿病人血糖，血脂肪及体重等控制有莫大的影响! 而营养师
与糖尿病卫教师，也总不忘一再叮咛且教导病友如何作醣类计算，与糖份斤斤计较!
2006年发表於糖尿照护(Diabetes Care)，比较全素低脂饮食计画与美国糖尿病学会所
推广的醣类计算饮食，发现，两种皆能够有效控制血糖，然而全素饮食对血糖的降低比
糖类计算来的更加有效。作者 Barnard et al. 表示，全素饮食有效控制血糖主要原因
可能来自较低的热量及脂肪，在此情况下，全素试验组的体重降低较多，可能因此增加
胰岛素敏感度。 此外，高脂饮食，在之前的研究发现，可能造成肌肉细胞及肝脏细胞
囤积较多的脂肪，导致细胞对胰岛素不敏感! 而胰岛素不敏感是导致第二型糖尿病重
要因子。
提高胰岛素敏感度最好的方法: 运动，减重。
此研究中，营养师卫教全素组受试者，选择低脂食物，在醣类方面则是尽量选择生糖指
数较低的食物，例如较粗糙，未经精緻的五穀根茎类。 然而并未在份量上加以限制。
在医院... 阅读全帖 |
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