GENERAL MEDICINE

GENERAL MEDICINE.

M.YASHWITHA. 

ROLL.NO:73.


35 F WITH AKI ON CKD

 A 35 year female, resident of manipaka, came to casualty with complaints of bilateral pedal edema since 20 days,decreased urine output since 20 days,Facial puffiness , shortness of breath ( a/w orthopnea and PND ) ..

H/O fever spike +, 10 days back, not associated with chills and rigor, subsided on taking medication.

C/o cough with expectoration, (yellowish in colour).

Pt was apparently asymptomatic 2 months back then she developed chest pain for which she visited local hospital in miryalaguda , on evaluation she was diagnosed to have chronic kidney disease and low hemoglobin, 2PRBC Transfusions were done 

After PRBC transfusion she developed b/l pedal edema, which subsided on medication.,

 • 20 days back she developed b/l pedal edema, reduced urine output, sob a/w orthopnea, and PND, and facial puffiness. 

•10 days back she developed fever a/w chills and rigor, which subsided on medication.1 PRBC transfusion done in Nalgonda hospital yesterday.

K/c/o HTN since 3 year's

Not a k/c/o DM, asthma, TB.

On Examination: 

pt is c/c/c,

Pallor -present 

Icterus - absent

Cyanosis - absent

Clubbing - absent

Lymphadenopathy - absent

Pedal edema - b/l present











Vitals:

Afebrile

Bp: 170/100 mm hg

PR: 99 bpm

RR: 22 cpm

SpO2: 87% @RA

CVS: S1,S2 +

RS: BAE+

P/A: SOFT, NON TENDER

CNS: NAD 


Outside reports on 30/11/21: 






















2/12/21:






PROVISIONAL DIAGNOSIS:

AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months.


Plan of care: 

1. Head end elevation upto 30'

2. O2 supplementation if SpO2 < 90%

3. Inj. Lasix 40mg iv tid 

4. Inj. PIPTAZ 2.25gms IV BD ( D1)

5. TAB. NICARDIA 10MG PO BD 

6. TAB. NODOSIS 550MG PO BD 

7. TAB. SHELCAL 500 MG PO OD 

8. NEB. WITH SALBUTAMOL 2 RESIPULES / 4TH HRLY,

9. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

10. SYP. ASCORYL PO TID 

11. HRLY VITALS MONITORING.





Day 2:

https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html


Pt shifted to CKD ward

35 year old female

S:

Sob reduced

Pedal edema reduced

O: 

Pt is c/c/c

Pallor +

B/l Pedal edema +

No icterus, cyanosis, clubbing, lymphadenopathy

VITALS:

Afebrile

Bp: 160/80 mm hg

PR: 88 bpm

RR: 22 cpm

SpO2: 92% @RA

CVS: S1,S2 +

RS: BAE+, decreased breathsounds in b/l ISA, MSA

P/A: SOFT, NON TENDER

CNS: NAD 

A: AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months

P:

1. Head end elevation upto 30'

2. O2 supplementation if SpO2 < 90%

3. Inj. Lasix 40mg iv tid 

4. Inj. PIPTAZ 2.25gms IV BD ( D2)

5. TAB. NICARDIA 10MG PO BD 

6. TAB. NODOSIS 550MG PO BD 

7. Tab. Orofer XT PO/OD

8. TAB. SHELCAL 500 MG PO OD 

9. NEB. WITH SALBUTAMOL  2 RESIPULES / 4TH HRLY,

10. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

11. Inj. Iron sucrose 1 amp in 100ml NS

12. SYP. ASCORYL PO TID 

13. HRLY VITALS MONITORING


On 18 /12/21:




On 19/12/21


On 20/12/21



Day 3:

https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html

Pt shifted to CKD ward

35 year old female

S:

Sob reduced

Pedal edema reduced

O: 

Pt is c/c/c

Pallor +

B/l Pedal edema +

No icterus, cyanosis, clubbing, lymphadenopathy

VITALS:

Afebrile

Bp: 160/80 mm hg

PR: 88 bpm

RR: 22 cpm

SpO2: 92% @RA

CVS: S1,S2 +

RS: BAE+, decreased breathsounds in b/l ISA, MSA

P/A: SOFT, NON TENDER

CNS: NAD 

A: AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months

P:

1. Head end elevation upto 30'

2 .Inj. Lasix 40mg iv tid 

3. TAB. NICARDIA 10MG PO BD 

4. TAB. NODOSIS 550MG PO BD 

5. Tab. Orofer XT PO/OD

6. TAB. SHELCAL 500 MG PO OD 

7. NEB. WITH SALBUTAMOL 2 RESIPULES / 4TH HRLY,

8. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

9. Inj. Iron sucrose 1 amp in 100ml NS

Day:4

https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html


In CKD WARD

35 year old female

S:

Sob reduced

Pedal edema reduced

O: 

Pt is c/c/c

Pallor +

B/l Pedal edema +

No icterus, cyanosis, clubbing, lymphadenopathy

Vitals:

Afebrile

Bp: 160/80 mm hg

PR: 88 bpm

RR: 22 cpm

SpO2: 92% @RA

CVS: S1,S2 +

RS: BAE+, decreased breathsounds in b/l ISA, MSA

P/A: SOFT, NON TENDER

CNS: NAD 

A: AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months

P:

1. Head end elevation upto 30'

2 .Inj. Lasix 40mg iv tid 

3. TAB. NICARDIA 10MG PO BD 

4. TAB. NODOSIS 550MG PO BD 

5. Tab. Orofer XT PO/OD

6. TAB. SHELCAL 500 MG PO OD 

7. NEB. WITH SALBUTAMOL 2 RESIPULES / 4TH HRLY,

8. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

9. Inj. Iron sucrose 1 amp in 100ml NS




































35 F WITH AKI ON CKD

 A 35 year female, resident of manipaka, came to casualty with

 c/o b/l pedal edema since 20 days,

decreased urine output since 20 days,

Facial puffiness , shortness of breath ( a/w orthopnea and PND ) 

H/O fever spike +, 10 days back, not associated with chills and rigor, subsided on taking medication.

C/o cough with expectoration, yellowish in colour,

Pt was apparently asymptomatic 2 months back then she developed chest pain for which she visited local hospital in miryalaguda , on evaluation she was diagnosed to have chronic kidney disease and low hemoglobin, 2PRBC Transfusions were done 

After PRBC transfusion she developed b/l pedal edema, which subsided on medication.,

 20 days back she developed b/l pedal edema, reduced urine output, sob a/w orthopnea, and PND, and facial puffiness. 

10 days back she developed fever a/w chills and rigor, which subsided on medication.

1 PRBC transfusion done in Nalgonda hospital yesterday.

K/c/o HTN since 3 year's

Not a k/c/o DM, asthma, TB.

O/E : 

pt is c/c/c,


Icterus - absent

Cyanosis - absent

Clubbing - absent

Lymphadenopathy - absent

Pedal edema - b/l present







Vitals:

Afebrile

Bp: 170/100 mm hg

PR: 99 bpm

RR: 22 cpm

SpO2: 87% @RA

CVS: S1,S2 +

RS: BAE+

P/A: SOFT, NON TENDER

CNS: NAD 

Outside reports on 30/11/21:














PD: AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months.

Plan of care: 

1. Head end elevation upto 30'

2. O2 supplementation if SpO2 < 90%

3. Inj. Lasix 40mg iv tid 

4. Inj. PIPTAZ 2.25gms IV BD ( D1)

5. TAB. NICARDIA 10MG PO BD 

6. TAB. NODOSIS 550MG PO BD 

7. TAB. SHELCAL 500 MG PO OD 

8. NEB. WITH SALBUTAMOL 2 RESIPULES / 4TH HRLY,

9. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

10. SYP. ASCORYL PO TID 

11. HRLY VITALS MONITORING.



Day 2:

https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html


Pt shifted to CKD ward


35 year old female


S:

Sob reduced

Pedal edema reduced


O: 

Pt is c/c/c

Pallor +

B/l Pedal edema +

No icterus, cyanosis, clubbing, lymphadenopathy


Afebrile


Bp: 160/80 mm hg


PR: 88 bpm


RR: 22 cpm


SpO2: 92% @RA



CVS: S1,S2 +


RS: BAE+, decreased breathsounds in b/l ISA, MSA


P/A: SOFT, NON TENDER


CNS: NAD 


A: AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months


P:


1. Head end elevation upto 30'

2. O2 supplementation if SpO2 < 90%

3. Inj. Lasix 40mg iv tid 

4. Inj. PIPTAZ 2.25gms IV BD ( D2)

5. TAB. NICARDIA 10MG PO BD 

6. TAB. NODOSIS 550MG PO BD 

7. Tab. Orofer XT PO/OD

8. TAB. SHELCAL 500 MG PO OD 

9. NEB. WITH SALBUTAMOL  2 RESIPULES / 4TH HRLY,

10. INJ. ERYTHROPOIETIN 4000 

https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html


Pt shifted to CKD ward


35 year old female


S:

Sob reduced

Pedal edema reduced


O: 

Pt is c/c/c

Pallor +

B/l Pedal edema +

No icterus, cyanosis, clubbing, lymphadenopathy


Afebrile


Bp: 160/80 mm hg


PR: 88 bpm


RR: 22 cpm


SpO2: 92% @RA

CVS: S1,S2 +


RS: BAE+, decreased breathsounds in b/l ISA, MSA


P/A: SOFT, NON TENDER


CNS: NAD 


A: AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months


P:


1. Head end elevation upto 30'

2 .Inj. Lasix 40mg iv tid 

3. TAB. NICARDIA 10MG PO BD 

4. TAB. NODOSIS 550MG PO BD 

5. Tab. Orofer XT PO/OD

6. TAB. SHELCAL 500 MG PO OD 

7. NEB. WITH SALBUTAMOL 2 RESIPULES / 4TH HRLY,

8. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

9. Inj. Iron sucrose 1 amp in 100ml NS

Day:4

https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html

In CKD WARD

35 year old female

S:

Sob reduced

Pedal edema reduced

O: 

Pt is c/c/c

Pallor +

B/l Pedal edema +

No icterus, cyanosis, clubbing, lymphadenopathy

Afebrile

Bp: 160/80 mm hg

PR: 88 bpm

RR: 22 cpm

SpO2: 92% @RA

CVS: S1,S2 +

RS: BAE+, decreased breathsounds in b/l ISA, MSA

P/A: SOFT, NON TENDER

CNS: NAD 

A: AKI ON CKD (stage v), with egfr: 5ml/hr, with metabolic acidosis ( resolving ), with b/l pleural effusion with k/c/o HTN since 10 months


P:

1. Head end elevation upto 30'

2 .Inj. Lasix 40mg iv tid 

3. TAB. NICARDIA 10MG PO BD 

4. TAB. NODOSIS 550MG PO BD 

5. Tab. Orofer XT PO/OD

6. TAB. SHELCAL 500 MG PO OD 

7. NEB. WITH SALBUTAMOL 2 RESIPULES / 4TH HRLY,

8. INJ. ERYTHROPOIETIN 4000 IU S/C WEEKLY ONCE 

9. Inj. Iron sucrose 1 amp in 100ml NS




















 

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