Foamy urine/bubbly urine 泡泡尿

隨著主治醫師查房時，主治醫師詢問病患：泡泡尿的情況有沒有改善呀？該病患為腎病症候群患者因嚴重水腫住院。不禁發愣了一下，我也經常會有尿中帶泡泡的情形呀，該不會有腎臟病吧？不是之前尿液檢查都正常嗎？不過話說回來，住院醫師都當兩三年了，這樣的"小"問題還不求甚解，似乎有點丟臉 :P

老樣子，Google it!

KingNet國家網路醫院
http://hospital.kingnet.com.tw/essay/essay.html?pid=8325&category=%E9%81%93%E8%81%BD%E4%B8%8D%E5%A1%97%E8%AA%AA

高雄榮民總醫院教研部醫學研究科主任　林興中醫師：
正常人每天會排出30 毫克以下的白蛋白，只要不超過30 mg即不要緊，這些蛋白經細菌分解而產生氣體，導致氣泡的出現，時間愈久，產生的氣泡愈多，故早上醒來的第一泡尿氣泡較多。
三軍總醫院內科部腎臟科主治醫師　林石化醫師：
沒有身體症狀的泡泡尿，多半是沒有腎疾病的。大多與飲食有關，例如尿液偏鹼性時，易起泡，為了確認有無問題，應看醫師做檢查。

→果然林石化教授所言字字珠璣，之前閱讀其著作和論文都有很大的收穫。[沒有身體症狀的泡泡尿，多半是沒有腎疾病的]→聽完這句話安心不少。


Foamy urine: What does it mean?
http://www.mayoclinic.com/health/foamy-urine/AN01702

Foamy urine is likely nothing to worry about if it happens only occasionally and isn't getting progressively more noticeable. It may just mean that you urinated rapidly, maybe with more concentrated urine — such as due to mild dehydration. You could drink more water to see if it goes away.
However, persistently foamy urine can be a sign of protein in your urine (proteinuria), which requires further evaluation. Large amounts of protein in urine may indicate a serious kidney problem.
If you're concerned about foamy urine, consult your doctor. He or she may recommend a urine analysis, which can detect protein in urine. If protein is detected in your urine, your doctor likely will recommend additional tests to determine the cause.

Answer by Mayo Clinic urologist Erik Castle, M.D.

→尿尿太"大港"使得進入馬桶後衝力太強勁，所以男性站著小便加上重力加速度，應該是比女生容易有泡泡產生。另外就是跟尿液濃度有關了，如果有輕微脫水，比方說喝太少水、運動完或是起床後第一次小便會容易出現泡泡尿。不過是不是有蛋白尿，還是應該做尿液分析比較準確。


阿倫的小結論：
Asymptomatic foamy urine
+ negative protein test in urine routine
= Rapid or concentrated urine
= Don't worry!

Hyperacute T-wave

今天evening nephro round Dr.楊請大家上台畫出MI和hyperkalemia其個別hyperacute T-wave。你能描述差異在哪並畫出來嗎?

Wikipedia:

The earliest electrocardiographic finding of acute myocardial infarction is sometimes the hyperacute T wave, which can be distinguished from hyperkalemia by the broad base and slight asymmetry.

http://en.wikipedia.org/wiki/Electrocardiogram#T_wave

→高血鉀的hyperacute T wave是寬底而有微小的不對稱。

UpToDate:

Peaked T waves —
Hyperacute or peaked T waves are usually the result of hyperkalemia. They are generally >10 mm in height as measured in the precordial leads, and >5 mm in height in the limb leads. The T wave is not only tall, but it is peaked and symmetric. This appearance is in contrast to the normal T wave which is asymmetric (the initial upstroke is slow while the end or downstroke is rapid).

In addition to hyperkalemia, hyperacute T waves may be seen in the early phases of an acute myocardial infarction or with myocardial ischemia, conditions which are associated with localized extracellular hyperkalemia. Tall T waves may also be seen in the presence of left ventricular hypertrophy, in which the amplitude of the QRS complex is increased, or may even be a normal variant; in these cases, the T waves are not peaked and still have an asymmetric morphology.

Hyperacute (peaked) T waves

Hyperacute T waves are >5 mm in the limb leads, and usually >10 mm in the precordial leads. They have a peaked, symmetric morphology.

http://www.uptodate.com/online/content/topic.do?topicKey=electuto/6828&selectedTitle=7~150&source=search_result#14

→高血鉀的T wave又高又尖又對稱。
有多高呢?在前胸導，常高於2大格；在肢導，長高於一大格。

→AMI早期可能看到hyperactue T wave
(基本理論是 localized "extra"cellular hyperkalemia，
我是第一次看到說明AMI有hyperactive T wave的原因，似乎蠻合理的)
這時後的T waves的確是有高起來，但是並沒有到 peaked的程度，
而且T wave的形狀是不對稱的。

ABC of clinical electrocardiography

The earliest signs of acute myocardial infarction are subtle and include increased T wave amplitude over the affected area. T waves become more prominent, symmetrical, and pointed ("hyperacute"). Hyperacute T waves are most evident in the anterior chest leads and are more readily visible when an old electrocardiogram is available for comparison. These changes in T waves are usually present for only five to 30 minutes after the onset of the infarction and are followed by ST segment changes.


















http://www.bmj.com/cgi/content/full/324/7341/831

→AMI的hyperacute T wave經常是MI剛開始5到30分鐘的心電圖表現，
過了半小時後就會開始ST chamge。

阿倫小筆記：

Tall, peaked, symmetrical, broad base T waves
= Hyperkalemia T wave !!

peaked,ㄚ是有多尖呢？應該是可以刺傷手指頭吧 :)




Tall, asymmetrical, very broad baseT waves

= AMI hyperacuteT wave !!

不對稱的T波是緩升陡降，為什麼會緩升是因為常伴隨ST segment change，如果詢問有胸痛情形，接下來應該是馬上進行近乎反射的動作：MONA+call CV man+評估thrombolytic agent使用。