A 70 year old female patient with Acute kidney injury secondary to urosepsis on chronic kidney disease secondary to hypertension nephropathy

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 


Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

CHIEF COMPLAINT:

A 70 years old female, who is a housewife came to OPD with chief complaints of lower backache with generalised waekness(unable to sit) since 1 week and decreased urine output  since 3 days, bilateral pedal edema since 3 days.

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic one week back then she developed  Bilateral loin pain radiating upto inner thigh since 2-3 years, which is increased from last one week associated with decreased urine output and bilateral pedal edema upto ankle.

She is evaluated as hyponatremic (dyselectrolytemia)

Na+ = 117 mEql/L

K+ = 2.8 mEql/L

PAST HISTORY:

She is a known case of CKD since 2016 and hypertension since 5 years

Not a known case of diabetes, asthma, epilepsy, tuberculosis 

She underwent HD (HEMODIALYSIS) in 2019.

TREATMENT HISTORY:

she is on conservative management along withHypertension on regular medication 

She underwent HD (HEMODIALYSIS) in 2019.

PERSONAL HISTORY:

Appetite-  loss of appetite 

Diet- mixed

Bowel habits- regular 

Bladder habits-  decreased urine output from 3 days

Sleep- adequate 

Addictions- no addictions

Allergies- no allergies

FAMILY HISTORY:

Insignificant 

GENERAL EXAMINATION:

Conscious, coherent and cooperative 

Well oriented to time, place and person 

Moderately built and moderately nourished 

Pallor- PALLOR PRESENT (severe)

Icterus- No icterus

Cyanosis- No Cyanosis 

Clubbing- No clubbing 

Generalised lymphadenopathy- No generalised lymphadenopathy 

Pedal edema- BILATERAL PEDAL EDEMA UPTO ANKLE

Malnutrition- No

Dehydration-  Mild

Vitals:

Day-1:

Temperature - afebrile 

Pulse rate- 93 bpm

Respiratory Rate- 14 cycles per minute

Blood Pressure- 160/80 mm of Hg

GRBS- 152 mg/dl

Day-2:

Temperature - afebrile 

Pulse rate- 96 bpm

Respiratory Rate- 14 cycles per minute

Blood Pressure- 150/60 mm of Hg

GRBS- 152 mg/dl

Day-3:

Temperature - afebrile 

Pulse rate- 84 bpm

Respiratory Rate- 14 cycles per minute

Blood Pressure- 170/90 mm of Hg

SpO2- 100% at room air

GRBS- 176 mg/dl

SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM- S1 and S2 heart sounds heard, no murmers and thrills

RESPIRATORY SYSTEM- Bilateral air entry present with vesicular breath sounds and no added sounds. No dyspnoea, wheeze

CENTRAL NERVOUS SYSTEM- intact

Consciousness  - Conscious

Speech - normal

Signs of meningeal irritation :

 Neck stiffness - no

kerning's sign - no

Cranial nerves- normal 

Motor system - normal

Sensory system - normal 

Glassgow scale - normal

PER ABDOMEN- no organomegaly 

Shape - scaphoid

Tenderness - non tender

Palpable mass - no

Hernial orifices- normal

Liver - not palpable 

Spleen - not palpable

Bowel sounds - heard and normal

Genitals - normal

INVESTIGATIONS:

RAPID ANTIGEN TEST: NEGATIVE 













ABG:

Day -1;

pH - 7.26 

pCO2- 20 mm Hg

SpO2- 95.9%

Serum HCO3 = 11.5 mmol/L

HCO3(a) = 8.7 - 8.0

Day-2;






Serum electrolytes:

Day-1;





Day-2;






Serum creatinine:

Day-1;  6mg/dl

Day-2;  5.7mg/dl

Hemogram:








Blood urea:

Day-1;  91mg/dl

Day-2;  132 mg/dl

DIAGNOSIS:ACUTE KIDNEY INJURY(AKI) SECONDARY TO UROSEPSIS ON CHRONIC KIDNEY DISEASE(CKD) SECONDARY TO HYPERTENSION NEPHROPATHY.

TREATMENT:

Day-1;

IVF NS or RL 10.9% at 100ml/hour

INJ. PIPTAZ 2.25gm/IV/BD

INJ. PANTOP 40mg/IV/OD

TAB. NICARDIA 20mg/PO/BD

TAB. NODOSIS 550mg/PO/TID

TAB. OROFER-XT/PO/BD

TAB.SHELCAL /PO/OD

INJ. ERYTHROPOIETIN 4000IU/SC WEEKLY ONCE

INJ. NaHCO3 100mEql/slow IV/stat/

INJ, TRAMADOL 1 amp in 100NS/IV/BDAFTER INJ. ZOFER 4CC/BD

SYRUP. POTCHLOR 16ml/PO/TID

INJ. LASIX 40mg/IV/BD

Advice:

ORTHOPAEDIC opinion for bilateral hip pain

ORTHOPAEDIC ADVICED TREATMENT:

TAB. DOLO 650mg BD FOR 1 WEEK

TAB. SHELCAL OD FOR 3 WEEKS

TAB. LIMCEE TID FOR 10 DAYS

Day-2;

IVF.NS(0.9%) AT 75ml/hour if altered sensorium persists,

 3%NaCl at 10ml/hour

INJ. PIPTAZ 4.5gm/IV/stat after sending urine sample

 INJ. PIPTAZ 2.25gm/IV/BD

INJ. PANTOP 40mg/IV/OD

TAB. NICARDIA 20mg/PO/BDBP/PR/TEMPERATURE/ SpO2 HOURLY STRICT I/O CHARTINGTAB. 

NODOSIS 550mg/PO/BD

TAB. OROFER- XT /PO/BD

INJ. ERYTHROPOIETIN 4000IU/SC/ONCE WEEKLY








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