AKI secondary to ?viral infection /NSAID abuse
A 45 yr old female who is farmer by occupation.,with h/o B/L knee pains (? Osteoarthritis) taken injections for pain relief by RMP for every 2-3 days since 1yr .no h/o small joint pains or early morning stiffness
She was apparently asymptomatic 1 1/2 month back -had fever, which lasted for 6days, low grade intermittent -pt had taken T. Dolo 650mg TID for 3days following which pt became hypoactive (drowsy but arousable) -was taken to hospital on 11/8/21 where routine investigations done, showed plt count of 7000 (for which 1 SDP transfusion was done) with denovo HTN(170/90) and DM 2 (GRBS-233) and managed conservatively -diagnosed as MODS WITH AKI WITH ENCEPHALOPATHY as pt had become disoriented to place then DIALYSIS was initiated (then her cr 4,4 urea-181) and repeted every 2 days
No h/o recurrent oral ulcers, joint pains
Past history : 6 months back surgery for renal stones, hysterectomy
Personal history :
Loss of appetite
Mixed diet
B&B -regular and normal
No known allergies
No addictions
On examination :
No pallor, cyanosis, clubbing, generalised lymphadenopathy
ANASARCA+
her vitals are
PR-116bpm
BP-170/90
RR-22cpm
Spo2- 92
Grbs-170mg%
SYSTEMIC EXAMINATION :
cvs: s1 s 2 heard
R/s: bae+ nvbs heard
P/A: distended abdomen, bowel sounds heard
Cns: pt is conscious
Speech -normal
No signs of meningeal irritation
Cranial nerves examination - normal
Motor, sensory system examination -normal
GCS -15/15
PROVISIONAL DIAGNOSIS :
AKI SECONDARY TO ?viral infection /NSAID ABUSE with k,/c/o HTN and DM-ll
Investigations:
Outside the hospital:
OPHTHALMOLOGY OPINION:
On 6/9/21:
24 hr URINARY volume -1500ml
24 hr URINARY Protein-236mg/day
24 hr URINARY creatinine-0.6g/day
NEPHROLOGY OPINION:
On 8/9/21:
On 9/9/21:
Combs test:
DCT- POSITIVE
ICT-NEGATIVE
DERMATOLOGIST OPINION :
On 11/9/21:
Salt restriction lessthan 2.4g per day
Fluid restriction lessthan 1.5 l/day
Inj Lasix 40 mg iv/bd
Inj Ceftriaxone 1gm IV/bd
Inj. PANTOP 40mg IV/od
Inj.zofer 4mg IV/sos
Inj Neomol 100 ML NS IV/sos
T.Pcm 500 mg po/bd
T.orofer xT po/od
Bp/PR/TEMP/RR CHARTING 4TH HRLY
Grbs charting 6th hrly
Inj HAI s/c acc to sliding scale
I/o charting
T.cilnidipine 5 mg od
T.Arkamine 0.1 mg po/od
On 5/9/21:
S-
Vomitings of 2episodes since yesterday
Stools not passed
O-
Pt is c/c/c
Afebrile
BP-190/100 mmHg
PR -120bpm
Spo2-96 %on RA
RR-21cpm
Grbs-134
I/o-900/550
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj Ceftriaxone 1gm IV/bd
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj pantop 40 mg iv/od
Inj zofer 4mg IV/sos
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
Inj.HAI s/c acc to sliding scale
Inform Grbs
Strict i/o charting
On 6/9/21:
S-
No fresh complaints
Vomitings subsided
Decreased appetite
Stools not passed
O-
Pt is c/c/c
Afebrile
BP-160/190 mmHg
PR -106bpm
Spo2-96 %on RA
RR-21cpm
Grbs-112mg/dl
I/o-900/550
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj Ceftriaxone 1gm IV/bd
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj pantop 40 mg iv/od
Inj zofer 4mg IV/sos
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
Inj.HAI s/c acc to sliding scale
Inform Grbs
Strict i/o charting
Syp.cremaffin plus po/hs
On 7/9/21:
S-
No fresh complaints
Stools not passed
O-
Pt is c/c/c
Afebrile
BP-170/190 mmHg
PR -98bpm
Spo2-98 %on RA
RR-20cpm
Grbs-186
I/o-1300/1150
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard ,decreased breath sounds in b/l IAA,ISA
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj Ceftriaxone 1gm IV/bd
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj pantop 40 mg iv/od
Inj zofer 4mg IV/sos
T.Metformin 500 mg po/od
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
T.Aldactone 25mg po/od
2-3egg whites /day
Grbs -6th hrly
Monitor vitals 4th hrly
Strict i/o charting
Protein powder-D (sugar free) 2 spoons in one glass of milk -bd
On 8/9/21:
S-
No fresh complaints
Stools not passed
O-
Pt is c/c/c
Afebrile
BP-130/80mmHg
PR -86bpm
Spo2-98 %on RA
RR-22cpm
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard ,decreased breath sounds in b/l IAA,ISA
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj Ceftriaxone 1gm IV/bd
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj pantop 40 mg iv/od
Inj zofer 4mg IV/sos
T.Metformin 500 mg po/od
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
T.Aldactone 25mg po/od
2-3egg whites /day
Grbs -6th hrly
Monitor vitals 4th hrly
Strict i/o charting
Protein powder-D (sugar free) 2 spoons in one glass of milk -bd
On 9/9/21:
S-
No fresh complaints
Stools not passed
O-
Pt is c/c/c
Afebrile
BP-150/60 mmHg
PR -88bpm
Spo2-98 %on RA
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj zofer 4mg IV/sos
T.Metformin 500 mg po/od
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
T.Aldactone 25mg po/od
2-3egg whites /day
Grbs -6th hrly
Monitor vitals 4th hrly
Strict i/o charting
Protein powder-D (sugar free) 2 spoons in one glass of milk -bd
On 10/9/21:
S-
No fresh complaints
Stools not passed
O-
Pt is c/c/c
Afebrile
BP-140/80 mmHg
PR -84bpm
Spo2-98 %on RA
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj zofer 4mg IV/sos
T.Metformin 500 mg po/od
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
T.Aldactone 25mg po/od
2-3egg whites /day
Grbs -6th hrly
Monitor vitals 4th hrly
Strict i/o charting
Protein powder-D (sugar free) 2 spoons in one glass of milk -bd
On 11/9/21:
S-
No fresh complaints
Stools passed yesterday night
O-
Pt is c/c/c
Afebrile
BP-140/80 mmHg
PR -82bpm
Spo2-98 %on RA
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj zofer 4mg IV/sos
T.Metformin 500 mg po/od
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
T.Aldactone 25mg po/od
2-3egg whites /day
Grbs -6th hrly
Monitor vitals 4th hrly
Strict i/o charting
Protein powder-D (sugar free) 2 spoons in one glass of milk -bd
On 12/9/21:
S-
No fresh complaints
Stools not passed
O-
Pt is c/c/c
Afebrile
BP- mmHg
PR -bpm
Spo2-98 %on RA
CVS- s1 s2 heard
Cns- NAD
R/s- NVBS heard
P/A- soft
A-
AKI SECONDARY TO?viral infection/NSAID ABUSE with k/c/o HTN and DM-ll
P-
Fluid restriction lessthan 1l per day
SALTRESTRICTION lessthan 2.4g per day
Inj lasix iv/tid(60mg-60mg-40 mg)
Inj zofer 4mg IV/sos
T.Metformin 500 mg po/od
T.CINOD 10mg po/bd
T.Arkamine 0.1 mg po/bd
T.Nodosis 500mg po/bd
T.orofer xT po/od
T.Pcm 500mg po/sos
T.Aldactone 25mg po/od
2-3egg whites /day
Grbs -6th hrly
Monitor vitals 4th hrly
Strict i/o charting
Protein powder-D (sugar free) 2 spoons in one glass of milk -bd
