Hong Kong 26 - 30 Nov 2013

My last visit to Hong Kong was 2 years ago. I remember blogging about the trip - if I don't recall wrongly we had spent a considerable amount of time eating and shopping.

Not sure why my family chose to go back. But 2 years later we are back for more. Maybe we have an insatiable appetite for eating and shopping.

The Hong Kong Skyline taken during a stroll about Victoria Peak

Interesting sign. Also found on Victoria Peak.

A stroll at Victoria park in the morning led us to this pleasant surprise. I am pretty sure that is not an owl.

Me looking downright silly while celebrating our find of cifan. It has turned into an obsession but tastes pretty nice actually. Basically glutinous rice with pork floss, salted vegetables and You Tiao. I took a similar picture 2 years ago, and I believe this is the same stall - The Shanghai Hong Kong Noodle shop.

Took a ferry from Wan Chai to Tsim Sha Tsui and was rewarded with this view at 3pm in the afternoon. Great weather - sunny with cool temperatures, a rare find back home.

No we did not eat this in Hong Kong. The queue was way too long. This photo was taken from our hometown at Plaza Singapura, Singapore.

Ningbo-shanghai trip

I havent blogged for ages.

There's no particular reason except that my last posting was a particularly good one.
One that I hope i will remember for life.
A quick recap on events thus far:
- completed 3 months rai posting
- passed mrcp part 1
- went for shanghai holiday
- started accident and emergency posting
- and made lots of good friends along the way :)

How to differentiate between renal tubular acidosis, gittelman syndrome, bartter syndrome and liddle syndrome.

Acidosis! Hyperchloremia!

Renal tubular acidosis type I = Distal RTA = Decreased distal acidification. Urine pH > 5.3. Low to normal k. Nephrocalcinosis and renal stones due to hypercalciuria. Sjögren's syndrome, amphotericin. Give bicarbonate.

Type II = Proximal RTA = Decreased proximal bicarbonate absorption. Urine pH variable. Low to normal k. Rickets, osteomalacia, fanconi's syndrome = hypophosphatemia, hyperuricosuria, glycosuria. Multiple myeloma, acetazolamide, heavy metal poisoning. Treat cause, restrict sodium.

Type III = mixed type I and II 

Type IV = Aldosterone deficiency or resistance. Urine pH < 5.3. Hyperkalemia. Diabetes, primary adrenal insufficiency, spironolactone, amiloride, triamterine, tmp, pentamidine. Sodium restriction, frusemide.

Alkalosis! Hypokalemia! 

Bartter syndrome = hypokalemia, high urine calcium, act like loop diuretic (impaired sodium, k chloride reabsorption in TAL) Replace potassium, give amiloride, indomethacin. 

Gittelman syndrome = hypokalemia, low urine calcium, acts like thiazides diuretic (sodium chloride cotransporter). Hypomagnesemia ? Mechanism. Replace potassium, magnesium. K sparing diuretic.

Liddle syndrome = hypokalemia , metabolic alkalosis, hypertension. Hypoaldosteronism secondary to constitutive activation of sodium channel. Triamterine , amiloride . 

Six things I'm thankful for, and four more I wish could be better

1. Amazing colleagues who lend a listening ear and who never shy away from lending a helping hand

2. Supportive and understanding senior staff

3. Best family support one can ever wish for

4. Finding time to have breakfast and exercise with family

5. Best sister anyone can have. Even if she's overseas.

6. Relatively peaceful national day call. And the joy of not having any more calls for the rest of the month!

1. Sleep regularity. 

2. Work and study efficiency

3. Physical fitness (groan)

4. Work life balance (the elusive goal)