case 11

70 year old male 
DOA -30/08/24
DOD -06/09/24
Duration of CKD -not known

Diagnosis -

RENAL AKI ON CKD
GTCS SECONDARY TO HYPOGLYCEMIA?UREMIA? LEFT TODS PALSY
K/C/O CVA (?PCA STROKE)
K/C/O EPILEPSY,DM2,HTN SINCE 3YRS

 Case History and Clinical Findings
 C/O SEIZURES 3 DAYS AGO
DECREASED URINE OUTPUT SINCE 2 DAYS HOPI
PT WAS ASSYMPTOMATIC 3 DAYS AGO THEN SHE DEVELOPED SEIZURES GT TYPE ,INSIDIOUS IN ONSET,GRADUALLY PROGRESSIVE ASS. WITH
 DECREASED URINE OUTPUT
 PAST ILLNESS
K/C/O T2DM,HTN,SEIZURES A SINCE 2YRS AND ON MEDICATION

 GENERAL EXAMINATION :
PATIENT IS CONSCIOUS ,COHERENT , COPERATIVE
NO SIGNS OF PALLOR , ICTERUS, CYANOSIS, CLUBBING, LYMPH ADENOPATHY. PEDAL OEDEMA PRESENT 
TEMP: 98.3
 PR: 82BPM 
RR: 18 CPM
BP: 110/70MMHG 

SYSTEMIC EXAMINATION: 
CVS: S1 S2 HEARD. NO MURMURS
RS :TRACHEA- CENTRAL. BAE+
P/A- SOFT, NON- TENDER. BOWEL SOUNDS HEARD.
CNS: NO FOCAL NEUROLOGICAL DEFECTS


Investigation
RFT
UREA 108 mg/dl
CREATININE 5.0 mg/dl
URIC ACID 9.9 mmol/L
CALCIUM 8.3 mg/dl
PHOSPHOROUS 5.9 mg/dl
SODIUM 140 mmol/L
POTASSIUM 5.1 mmol/L.
CHLORIDE 104mmol/L
LFT 
Total Bilurubin 2.20 mg/dl
Direct Bilurubin 1.15mg/dl
SGOT(AST) 1626 IU/L
SGPT(ALT)  875 IU/L
ALKALINE PHOSPHATASE 153 IU/L
TOTAL PROTEINS 5.5 gm/dl
ALBUMIN 3.32 gm/dl
A/G RATIO 1.52

COMPLETE URINE EXAMINATION
ALBUMIN +++
SUGAR Nil

HEMOGRAM ON 6/9/23
HB 9.3 gm/dl
MCV-77.2
MCH-27.1
MCHC-28.2
TLC 7700 cells/cumm
PLATELETS 1.88 lakh/cumm

S.IRON -68
S.FERRITIN-213

Smear - normocytic normochromic
2D ECHO -EF -59% GRADE 1 DIASTOLIC DYSFUNCTION 
LVH +

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -0
ADMISSION IN ICU -0




ULTRASOUND ON 30/8/24
RT KIDNEY 9.5X3.4CM
LT KIDNEY 9.4X3.5CM
IMPRESSION INCREASED ECHOGENICITY OF RT KIDNEY
LEFT GRADE 1 RPD CHANGES


PSYCH REFERRAL WAS TAKEN I/V/O ?ALCOHOL WITHDRAWL
IMPRESSION DELERIUM DUE TO GENERAL MEDICAL CONDITION
ALCOHOL DEPENDENCE SYNDROME
Treatment Given(Enter only Generic Name)
IVF NS/DNS AT 30ML /HR
ALLOW ORAL FLUIDS
INJ THIAMINE 200MG IN 100ML NS IV/BD
INJ.LASIX 40MG IV/BD
INJ LEVIPIL 500MG IV/BD
INJ.PAM 40MG IV/OD
T.ECOSPIRIN 75MG PO/OB
T.ROSUVAS 10MG PO/OD
T.SWOCIT PLUS PO/OD
T.SEVELAMER 400MG PO/OD
T.UDILIV 300MG PO/BD
T.RISPERIDONE 1MG 1/2 TAB PO/BD

Advice at Discharge
SALT RESTRICTION LESS THAN 1.5 GRAM/DAY
WATER RESTRICTION LESS THAN 2 LITERS/DAY
T.NODOSIS 500MG PO/BD 8 AM-8PM
T.LASIX 40MG PO/BD8 AM-4PM
T.SHELCAL 500MG PO/BD 2PM
T.ECOSPIRIN 75MG PO/OD 2PM
T.ROSUVAS10MG PO/OD 8PM
 T.PAN 40MG PO/OD 8AM 
T.BIO D3 ONCE WEEKLY 
T.OROFER XT PO/OD
INJ HAI TID 4U-4U-4U
 INJ. EPO 4000IU S/C ONCE WEEKLY 
T.LEVIPIL 500MG IPO/TID 8AM-2PM-8PM T.RISPERIDONE 1MG 1/2 TAB PO/BD 8AM-8PM 3 DAYS


FOLLOW UP AFTER 3MONTHS 
HB-9.8
MCV -75.4
MCH-26.1
MCHC-29.1
TLC -12000
PLT -2.1


FOLLOW UP AT THE END OF THESIS 
HB-9.3
MCV -75 1
MCH-26.3
MCHC-28.8
TLC-10000
PLT -2.21

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