KEY SIGNS SYMPTOMS
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- Clinical manifestations of hypernatremia can be subtle, consisting of lethargy, weakness, irritability, neuromuscular excitability, and edema. With more severe elevations of the sodium level, seizures and coma may occur.Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157 mEq/L (normal blood levels are typically about 136-145 mEq/L for adults and elderly ). Values above 180 mEq/L are associated with a high mortality rate, particularly in adults. However such high levels of sodium rarely occur without severe coexisting medical conditions
- HyponatremiaSymptoms of hyponatremia include nausea and vomiting, headache, confusion, lethargy, fatigue, loss of appetite, restlessness and irritability, muscle weakness, spasms, or cramps, seizures, and decreased consciousness or coma. The presence and severity of symptoms are associated with the level of serum sodium (salt level in the blood), with the lowest levels of serum sodium associated with the more prominent and serious symptoms (the less the salt the more severe the symptoms). However, emerging data suggest that mild hyponatremia (serum sodium levels at 131 mEq/L or above) is associated with numerous complications and undiagnosed symptoms.Many medical illnesses, such as congestive heart failure, liver failure, kidney failure, or pneumonia may be associated with hyponatremia. These patients frequently show up in the medical exam room because of these other disease symptoms.
- Abdominal pain and tenderness
- The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness, and abdominal guarding, which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one's hips, or eliciting the Blumberg sign (a.k.a. rebound tenderness, meaning that pressing a hand on the abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place). The presence of these signs in a patient is sometimes referred to as peritonism. The localization of these manifestations depends on whether peritonitis is localized (e.g., appendicitis or diverticulitis before perforation), or generalized to the whole abdomen. In either case, pain typically starts as a generalized abdominal pain (with involvement of poorly localizing innervation of the visceral peritoneal layer), and may become localized later (with the involvement of the somatically innervated parietal peritoneal layer). Peritonitis is an example of an acute abdomen.
- Collateral manifestations
- Diffuse abdominal rigidity ("washboard abdomen") is often present, especially in generalized peritonitis
- Sinus tachycardia
- Development of ileus paralyticus (i.e., intestinal paralysis), which also causes nausea, vomiting and bloating.
- Sequestration of fluid and electrolytes, as revealed by decreased central venous pressure, may cause electrolyte disturbances, as well as significant hypovolemia, possibly leading to shock and acute renal failure.
- A peritoneal abscess may form (e.g., above or below the liver, or in the lesser omentum
- Sepsis may develop, so blood cultures should be obtained.
Renal (Kidney) Failure
Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Renal failure accompanied by noticeable symptoms is termed uraemia. Symptoms of kidney failure include:
- High levels of urea in the blood, which can result in:
- Vomiting and/or diarrhea, which may lead to dehydration
- Weight loss
- Nocturnal urination
- More frequent urination, or in greater amounts than usual, with pale urine
- Less frequent urination, or in smaller amounts than usual, with dark coloured urine
- Blood in the urine
- Pressure, or difficulty urinating
- Unusual amounts of urination, usually in large quantities
- A build up of phosphates in the blood that diseased kidneys cannot filter out may cause:
- Bone damage
- Nonunion in broken bones
- Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)
- A build up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
- Abnormal heart rhythms
- Muscle paralysis
- Failure of kidneys to remove excess fluid may cause:
- Swelling of the legs, ankles, feet, face and/or hands
- Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
- Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
- Pain in the back or side
- Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
- Feeling tired and/or weak
- Memory problems
- Difficulty concentrating
- Low blood pressure
- Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred, after which symptoms include:
- Foamy or bubbly urine
- Swelling in the hands, feet, abdomen, or face
- Other symptoms include:
- Appetite loss, a bad taste in the mouth
- Difficulty sleeping
- Darkening of the skin
- Excess protein in the blood
- With high dose penicillin, renal failure patients may experience seizures
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