? PRE RENAL ACUTE KIDNEY INJURY ON CKD SECONDARY TO SEPSIS, METABOLIC ACIDOSIS. BILATERAL LOWER ZONE CONSOLIDATION.? DIC.

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


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.


Here is a case I have seen. 


INTERNS 
juveria 
Swarna 
Nikhil 
Manivarma
Divya

PGs
Dr. HAREEN (SR) 
Dr. Praneeth Y3
Dr. Vaishnavi Y2
Dr. Vinay Y1. 

60/F farmer by occupation,came with SOB since today morning, decreased urine output since yesterday morning. Fever since 3 -5days , generalised weakness since 5 days. 
Patient was apparently asymptomatic 5 days back . Patient complains of fever associated with chills, high grade on and , relieved with medication fr which she went to local hospital. 
Complain of loose stools 10 episode mucoud in consistency day before yesterday, not associated with pus, blood, non foul smelling ;went to local hospital relieved on medication. 
Since today morning she complained of SOB, decreased urine output. 
Pedal edema grade 1 , PND +.
No complaints of chest pain, palpitations, syncopal attacks, Orthopnea, constipation, abdominal pain, abdominal distention. 
K/c/O DM 2 since 15 years on regular medication(unknown medication). 
No k/c/O HTN, EPILEPSY, CVA, CAD, TB, ASTHMA. 
2 months back last binge occasionally toddy drinker, 2 chuttas perday since 20 years. 
On Examination:
pallor and odema , NO icterus, Cyanosis, clubbing, lymphadenopathy. 

VITALS:
PR:110bpm
BP:110/70mmhg
Spo2:95%@RA.
GRBS:125mg/dl.
CVS:S1S2 heard No murmurs. 
RS:BAE+, dyspnoea , bilateral fine crepts on inspiration IAA, ISA. 
Abdominal examination:Tenderness is present around umblical region, bowel sounds +.


INVESTIGATION:
TREATMENT :
1)Propped up posture. 
2) Ryles feeding- milk + protein powder 100 ml 4 th hourly, free water -100 ml - 4 th hourly
3) IVF - 1 UNIT DNS 
1 UNIT NS}  AT 50 ML / HOUR
1 UNIT RL } SLOWLY CONTINUOUS. 
4) INJ LASIX INFUSION @ 3 ml/hour.IV (INCREASE /DECREASE TO MAINTAIN SBP >110 mmhg) ( 80 mg IV Lasix in 40 ml NS). 
5) INJ. NORADRENALINE-@ 5ml /hour to (maintain SBP>110mmhg) 
6) Tab. Azithromycin 500mg OD. 
7) TAB. Piptaz 4.5 gm IV/STAT.
8) INJ. PIPTAZ 2.25gm/IV/TID.
9) INJ. PAN40mg IV/TID
10)INJ. ZOFER 4 mg /IV /TID.
11)INJ. HAI S/C according to GRBS. 
12)Neb. With DUOLIN 8th hourly
         WITH BUDECORT 12 th hourly. 
13)O2 inhalation (if spo2 <92%) . 








 

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