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Sahil - Roll no -143

August 11 2022

AKI SECONDARY TO ?VIRAL INFECTION /NSAID ABUSE

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.




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:







On5/9/22:


OPHTHALMOLOGY OPINION:
On 6/9/22:
24 hr URINARY volume -1500ml
24 hr URINARY Protein-236mg/day
24 hr URINARY creatinine-0.6g/day
on 7/9/22
NEPHROLOGY OPINION:
On 8/9/22:


On 9/9/22:
Combs test:
DCT- POSITIVE
ICT-NEGATIVE 

ORTHO OPINION:
DERMATOLOGIST  OPINION :
On 11/9/22:






Treatment:
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 5/9/22:
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 8/9/22:

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 9/9/22:
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 10/9/22:

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 11/9/22:
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 12/9/22:

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




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