AKI on CKD 2°to post renal, bilateral gross hydrourethronephrosis,right mid ureteric calculians s/p 3 sessions of hemodialysis 1 yr back

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A 45 year old female patient came to opd with chief complaints of reduced urine output since 1 week, easy fatigability since 1 week, shortness of breath since 3 days.

H/o presenting illness:-

Patient was apparently asymptomatic 1 week back later she developed reduced urine output and easy fatigability.SOB since 3 days , progressed to grade 3 to 4 (NYHA).

H/o hemodialysis of 3 sessions 1 year back.

Dialysis was initiated due to deranged RFT, metabolic acidosis to remove toxic metabolites. 

Patient had no response to speech from evening after hemodialysis. 

Today (18/2/22)- there was response and was orientated to time, place and person.

Past h/o:

Not a known case of Hypertension,Diabetes mellitus, Hypertension, Coronary Artery Disease, Chronic Kidney Disease, Asthma.

 

Vitals on admission:

Temperature: afebrile 

PR: 98 bpm

RR: 22cpm

BP: 160/80 mm Hg 

SpO2: 98%

GRBS: 106 mg/dal

CVS: S1 S2 present 

RS: BAE +

Treatment-

Inj lasix 50 mg iv /bd

Inj pan 40 mg iv /od

Inj.zofer 4 mg iv/od

Inj erythropoietin 4000iu s/c once weekly

Tab. Nodosis 500 mg po/bd

Tab.orofer ct po/od

Tab .shelcal po/od

Monitor vitals hourly.

INVESTIGATION ON 15/2/22

serology -negative

RBS-75

S.iron -62

BGT- B POSITIVE

ECG on 15/2/22

Usg on 15/2/22  - b/l hydrourethronephrosis

urology opinion ivo b/l hydrourethronephrosis

 

2D echo on 16/2/22

ECG ON 17/2/22

On 17/2/22 I/v/o hemodialysis- central line was placed.

Soap notes on 18/2/22

ICU BED 4

45Y/F

S:2 episodes of vomitings

O:

BP:120/80 MMHG

PR:112BPM

RR:22CPM

CVS:S1S2+

RS:BAE+

P/A: Soft, nontender

A: AKI on CKD 2° to post renal, bilateral gross hydrourethronephrosis,right mid ureteric calculians s/p 3 sessions of hemodialysis 1 yr back

P:inj.piptaz 2.25 gm iv /tid

Inj metrogyl 500mg 100ml iv /tid

Tab.nodosis 500 mg po/bd

Tab.shelcal ct po/od

Tab.orofer xt po/bd

Tab.zofer 4 mg iv/tid

RT foods- with 100 ml milk- 4 th hourly

100 ml water - 2 nd hourly

Underwent hemodialysis yesterday evening