AKI+ CKD+diabetic nephropathy +respiratory failure+pleural effusion+DM2
1)Shortness Of Birth since 20 days
2)Bilateral pedal edema since 20 days
3)Decreased urine output since 20 days
HISTORY OF PRESENTING ILLNESS
The patient was apparently asymptotic 20 days back.
Then she developed SOB of Grade 2 which was insidious in onset and gradually progressive associated with dry cough and fever of insidious onset
The patients attenders checked her GRBS which was 800mg/dl
She went to Hospital 1 and was found out to be COVID positive.( CT-21/25; CORADS-5)
It was also found out that there was a kidney problem (DKA?) and was started on Hemodialysis. She had 5 sessions of hemodialysis during her coarse of stay in Hospital 1
She turned out to be COVID negative on Day 8 of admission and was discharged with supplemtary o2 prescription
She stayed at home for 1 day but couldn’t breathe properly
27-8-21
She was brought to our hospital with complaints of
1)SOB which changed to grade 4 from grade 2
2)Bilateral pedal edema, a pitting type and was up to shin (mild)
3) Decreased urine output
The patient had 5 sessions of Hemodialysis (every alternate days) till date in this hospital
She had one day of relief from SOB after each dialysis session except for the latest session in which she developed SOB within hours
NO C/O LOSS OF APPETITE, VOMITING AND LOOSE STOOLS.
NO FACIAL PUFFINESS, NO H/O CHEST PAIN , ORTHOPNEA ADN PND
NO H/O YELLOWISH DISCOLORATION EYES
PAST HISTORY
The patient is a known case of Diabetes Mellitus since 8 years and was taking LINAGLIPTIN 5mg
There are no other complications
PERSONAL HISTORY
Diet- mixed
Appetite- normal
Bowel and bladder movements - urine output decreased
Bowel movements were regular
Addictions - none
FAMILY HISTORY
not significant
GENERAL EXAMINATION
The patient is coherent cooperative and conscious, well oriented to time place and person
She is moderately built and nourished
Pallor- present
Icterus- absent
Cyanosis-absent
Clubbing-absent
Edema-pedal, pitting
Lymphadenopathy -absent
VITALS
TEMPERATURE afebrile
RESPIRATORY RATE 45 cpm
BP 140/70
PULSE 100bpm
Spo2 80% at room atmosphere
On 02 supplementation (10lt) 88-90%
With bipap 95%
GRBS 353mg/dl
ABG showing metabolic acidosis .
on admission abg - ph - 7.28
pco2-33
hco3- 15 .4
SYSTEMIC EXAMINATION
CVS S1 S2 heard. No other murmurs heard
CNS Higher motor functions intact
PER ABDOMEN Soft and non tender
RESPIRATORY SYSTEM
BAE+ve, Crepitations heard(MA,IAA,ISA)
DIAGNOSIS
AKI (SECONDARY TO DRUG INDUCED,) CKD ( DIABETIC NEPHROPATHY WITH TYPE 1 RESPIRATORY FAILURE HFMEF
WITH DM 2 WITH MOD PLEURAL EFFUSION
INVESTIGATIONS
Chest X RAY
Day 1
Day 2
Day 3
Day4
HRCT
August 18
September 8
ECG - 8 September
ABG:
27/08/2021(2.:20PM)
PH: 7.28
PCO2:33
PO2:
St.HCO3:16.5
HCO3:15.4
27/08/2021(5:50PM)
PH: 7.26
PCO2:28.3
PO2:73.7
St.HCO3:14.1
HCO3:12.3
RFT;
Urea; 170
Creatinine:7.9
Uric Acid:4.3
Calcium;10
Phosphorus:8.2
NA+:133
K+:3.9
Cl- :104
RBS:305
Sr Iron: 72
LFT :
Total Bilirubin:1.16
Direct Bilirubin: 0.22
AST:27
ALT:10
ALP:211
TOTAL PROTEIN:6.8
ALBUMIN:3.1
A/G RATIO:0.85
8/9/2021
Hb 8.9
TLC 20000
Lymphocytes 12
PCT 27.4
RBC 3.29
ABG
PH- 7.4
PCO2- 24.9
Po2- 79.0
HCO3- 15.2
St.HCO3- 17.8
O2 sat - 88.9%
Blood urea- 118
Sr. Creatinine- 6.4
10/9/2021
Urea- 75
Creatinine- 5.4
Phosphorus- 5.5
Chloride- 97
Hb- 7.4
TLC- 13100
Lymphocytes- 14
PCV- 23.7
MCHC- 31.2
RBC- 2.74
ABG
PH- 7.38
PCO2- 29
Po2- 140
HCO3- 16.9
11/9/2021
Urea- 88
Creatinine- 6.4
Phosphorus- 5.2
Chloride- 98
Total bilirubin- 1.44
Direct bilirubin- 0.62
Alkaline phosphate- 281
Total proteins- 5.9
Albumin- 2.4
ABG
PH- 7.4
PCO2- 24.6
Po2- 80.8
HCO3- 15.1
THANKU AJIT SIR FOR THE ASSISTANCE
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