Vincent Chou, Days 2 and 3, Nephrology with Director Chen

Day 2:

A diabetic patient presents to the emergency room with coma. Hypoglycemia was found and glucose was administered, yet patient did not "snap out" of the coma, as expected in most cases. Today, we saw this patient in the ICU, and when Dr. Chen vigorously shakes the patient, his eyes open slightly but consciousness is obviously not fully restored. Why does the patient not respond to administration of glucose?

Reasons include:

1. Renal failure and uremia, which may lead to...
2. Electrolyte disturbance, e.g. hyponatremia, hypernatremia, 
3. Drug overdose, from recreational drugs or attempted suicide
4. CVA
5. Hepatic encephalopathy
6. Meningitis, encephalitis
7. Alcohol

All of these must be considered to find the etiology that contributed to the hypoglycemia-induced coma. I hope to see this patient recover fully in the following days as the medical team unveils a diagnosis and provides treatment.

Day 3:

A patient with chronic kidney disease has been seen by local clinics for some time, yet her disease is not controlled. She has been consoled to control her diet, yet her chronic kidney disease progresses from Stage 1 to Stage 5. She is currently admitted for acute on chronic kidney disease. She is experiencing symptoms of uremia (which for her include vomiting, fluid retention, anemia, fatigue). She has denied starting dialysis in the past, but with her kidneys at this stage, there are few other options for her. 

1. Kidney transplants is a viable option, yet there are very few donors. Similar to Japan, organ donation is not congruous with culture in Taiwan.
2. Hemodialysis requires an AV fistula, which takes an average of 6 weeks to mature before treatment can begin. Four hour sessions for three days per week at the hospital or hemodialysis clinic is required.
3. Peritoneal dialysis uses the peritoneum as a semipermeable membrane to replace kidney function. It requires a permanent tube in the abdomen, but some patients feel more in control of their bodies and feel more comfortable performing this method themselves in their home.

With proper patient education, chronic kidney disease can be adequately controlled at early stages to lessen the need for transplants and dialysis. Patients often need to be convinced of the severity of their situation then empowered to take their health into their own hands.