CKD 2° AKI due to SEPSIS

 The patient came to the opd with the chief complaints of - 

LOW BACK ACHE SINCE 1week 

LOSS OF APPETITE SINCE 1week 

FACIAL PUFFINESS SINCE 1week 

SHORTNESS OF BREATH (grade-III)


HOPI- 

Before 20yrs- an accident leading to splenectomy.

2019-

The patient was apparently asymptomatic 2yrs back when he had an injury on the Dorsum of right foot leading to ulceration. 

He went to the local hospital for the same and was found to be anemic (Hb-5.3). He was then referred to Khammam. 

In Khammam- they found out the was some derangement in the kidney from USG, RFT. He was told to have a kidney infection due to sepsis from the ulcer. 

He was discharged in a couple of days. 



October,2021- 

He was alright until 2months back, when he developed- FEVER, COLD, PEDAL EDEMA(PITTING TYPE), WEAKNESS.

He was taken to a hospital in Suryapet

He was diagnosed with CKD and HYPERTENSION. 

There, 1unit PRBC transfusion and complete debridement of the ulcer was done.

He was given medication for the deranged kidney function(apparently due to the infection of the foot- ?aki) and his anemia. 

Medication- inj.erythropoietin, tab.nodosis, tab.vit D3, tab.neurobion forte, tab.paracetamol.

The symptoms subsided in 3-4 days. They continued the medication for 1 1/2 month and didn’t know whether to continue the medication or not.

15/12/21- 

After a a couple of days of stoppage of the medication I.e. a week back he developed(15/12/21) - low backache, loss of appetite, sob grade-III, facial puffiness, pedal edema. 


Examination- 




Investigations- 















DIAGNOSIS- 
CKD ON AKI DUE TO SEPSIS.

TREATMENT- 

Tab.LASIX 40mg TID

Tab.NODOSIS 550mg OD

Tab.SHELCAL 500mg OD

Tab.OROFER-XT OD

Tab.NICARDIA 20mg BD

Inj.ERYTHROPOIETIN 4000IU S/c

Inj.IRON SUCROSE 1amp in 100ml NS

FLUID RESTRICTION <1L/day

SALT RESTRICTION <2.4gm/day


Comments

Post a Comment

Popular posts from this blog

PUO with a H/O RECURRENT SEIZURES IN A 18yr OLD MALE

Image
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.  E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. A 18 year old male who is  a student and a resident of Hyderabad presented with the chief complaints of  FEVER since 4 days.  Severe back pain since 4 days.    Vomiting since 4 days.   Generalised body pains since 4 days.  Cough without expectoration since 1 day .  History of presenting illness-  The patient was apparently asymptomatic till the age of 5 years.  h/o rt ear discharge with pain(on and off) since 1 year .— 2-3 episodes/yr lasting for 6-7 days. Last episode -
Read more

Case of 50 year old housewife with left sided upper and lower limb weakness with deviation of mouth to right side

Image
 This is the case I was given.  ( Hall ticket number:- 1601006118 ) A 50 year old housewife came to the casuality in the afternoon with presenting complaints of 1) Sudden onset Weakness in her left upper and lower limbs since 3 days 2) deviation of the angle of mouth to the right side since 3 days History of Present Illness: - Patient was apparently asymptomatic 3 days ago when at around 8:30 am in the morning while she was doing her daily chores she suddenly felt weakness in her left side of the body and couldnt move her left upper and lower limbs. The episode was sudden in onset and the evolution of weakness was completed within 6 hours. At the beginning of the attack , patient complained of dizziness followed by a fall onto her hips. She did not have any loss of consciousness before or after the fall. The patient's attendant observed that the patient had deviation of mouth to right side and that her speech was slurred and on giving her water to drink , he noticed that there was
Read more

Joints not so jointed?

Image
A 28yr old female resident of ramannagudem came to the OPD with C/O  - Multiple large joints since 2 months A/W loss of appetite and low grade fever.  Patient was apparently asymptomatic 2 months back when she had a missed period and when UPT tested — was positive(indicating pregnancy) .  Few days later she developed left foot pain initially in the EARLY MORNING- BURNING TYPE when pain progressed to the other side(right side). Then joint pains were ASCENDING and involved KNEE, HIP joints within 1 month, with left knee joint swelling since 15-20 days.  WRIST PAIN since 20 days and DIFFICULTY IN FISTING the hand since 10-15 days. No upper limb joint pains.  FEVER since 1 month- evening rise of temperature. No cough , no loose stools, no vomitings.  H/O MTP 1yr back for unplanned pregnancy.  N/K/C/O DM, HTN,CAD,ASTHMA,TB PERSONAL HISTORY: Appetite-normal Diet-mixed Regular bowel and bladder movements No addictions FAMILY HISTORY: Not significant OBSTETRIC HISTORY: H/o MTP 1yr back for unp
Read more