CASE OF A 60YR OLD FEMALE WITH PEDAL EDEMA
ACUTE KIDNEY INJURY SECONDARY TO UROSEPSIS
June 19, 2021
A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.
History of present illness:
The patient was apparently asymptomatic 10years back following which she was diagnosed with DM2 on checkup and on Teneligliptin 20 mg. In 2019 ( 2 years ago) she developed fever, shortness of breath and pedal edema and diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions)
Now presented with history of fever, high grade since 10 days, not associated with vomiting and loose stools . Patient complaints pedal edema bilateral and pitting type, with decreased urine output and burning micturition.
History of past illness:
Outside reports suggest acute kidney injury. Known case of diabetes mellitus since 10 years and on tab Teneligliptin 20 mg and not known case of hypertension, bronchial asthma, tuberculosis.
Personal history:
Married
Mixed diet
Normal Apetite
Adequate sleep
Bowel movement is regular
Decreased urine output and burning micturition
With no known allergies.
Consumes alcohol occasionally.
Family history:
No significant family history
General examination:
There is Pallor
There is no Icterus, cyanosis, clubbing
Generalized Lymphadenopathy
Edema is seen bilaterally witch is Pitting type pedal edema.
Vitals:
Temperature afebrile
Pulse rate is 111 beats per minute
Respiratory rate is 24 cycles per minute
Blood pressure measured on the left hand is 170/110 mm of Hg
Oxygen saturation at room air is 90 arm per mm Hg
Systemic examination:
Abdominal system:
No scars, sinuses, or any engorged veins.
Hernial orifices intact
Tenderness or guarding absent
No enlargement of liver, kidneys, or spleen
No ascites
Bowel sounds were normal.
Cardiovascular system:
cardiac sounds S1 S2 heard.
No cardiac murmurs
Thrills absent
Respiratory system:
No chest wall deformity
Trachea central
Expansion is symmetrical
Percussion note is resonant
Breath sounds normal, no wheeze or crackles heard.
Vocal resonance normal and symmetrical
Central nervous system:
No focal abnormality detected
Higher mental functions intact
Cranial nerves intact
reflxes normal
Speech normal
Provisional diagnosis:
Acute kidney injury secondary to urosepsis
Investigations ordered:
14/06/21
1. Complete urine examination:
2. ECG:
15/06/21:
1. Serum creatinine:
2. Blood sugar Fasting:
3. Blood sugar Random:
4. Blood Urea:
5. Serum Electrolytes:
6. Serum Potassium:
7. Urinary Chloride:
8 URINARY POTASSIUM
9. Urinary Sodium:
16/06/21
1. Serum Electrolytes:
2. Serum Creatinine:
3. Haemogram:
4. Blood urea:
5. ABG:
18/6/21
1. Serum creatinine:
2. Serum Electrolytes:
3.Haemogram:
4.Blood urea:
21/6/21
1. Complete Blood Picture (CBP)
Blood urea:
15/6/21 - 65 mg/dl
16/6/21 - 62 mg/dl
18/6/21 - 76 mg/dl
21/6/21 - 81mg/dl
Serum creatinine:
15/6/21 - 3.4 mg/dl
16/6/21 - 3.4 mg/dl
18/6/21 - 3.2 mg/dl
21/6/21 - 3.1 mg/dl
Total leukocytes count:
16/6/21 - 24700
18/6/21 - 26500
21/6/21 - 31700
Serum Electrolytes:
15/6/21 - Na: 139 ; K: 5.2 ; Cl: 106
16/6/21 - Na: 138 ; K: 5.1 ; Cl: 105
18/6/21 - Na: 136 ; K: 4.9 ; Cl: 102
21/6/21 - Na: 134 ; K: 5.5 ; Cl: 98
Diagnosis:
Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease
Treatment:
15/06/21:
Treatment:
Inj LASIX 40mg (8am- 2pm -8pm)
IVF - NS @ UO + 50 ml/hr
15/6/21, 5:30 p.m.
Treatment:
Inj LASIX 40mg (8am -2pm -8pm)
IVF - NS @ UO + 50 ml/hr
16/6/21
Treatment:
Inj LASIX 40 mg IV/TID 1 -1 - 1
IVF - NS @ UO + 50 ml/hr
Inj MAGNEXFORTE 1.5 gm/IV/BD
Tab NODOSIS - XT PO/OD
Inj HAI s/c
Neb plain Asthalin 4 respules 1 - 1 - 1 - 1
17/6/21
Treatment:
Inj LASIX 40 mg IV/TID 1 -1 - 1
IVF - NS @ UO + 50 ml/hr
Inj MAGNEXFORTE 1.5 gm/IV/BD
Tab NODOSIS - XT PO/OD
Tab OROFEA - XT PO/OD
Inj HAI s/c
Neb plain Asthalin 2 respules
Strict I/O charting
18/6/21
Treatment:
Inj LASIX 40 mg IV/TID 1 -1 - 1
IVF - NS @ UO + 50 ml/hr
Inj MAGNEXFORTE 1.5 gm/IV/BD
Tab NODOSIS - XT PO/OD
Tab OROFEA - XT PO/OD
Inj HAI s/c
Neb plain Asthalin 2 respules QID
Strict I/O charting
Tab ULTRACET 1/2 tab QID 1/2 - 1/2 - 1/2 - 1/2
19/6/21
Treatment:
Inj LASIX 40 mg IV/TID 1 -1 - 1
IVF - NS @ UO + 50 ml/hr
Inj MAGNEXFORTE 1.5 gm/IV/BD
Tab NODOSIS - 500 mg PO/OD
Tab OROFEA - XT PO/OD
Inj HAI s/c
Neb plain Asthalin 2 respules QID
Strict I/O charting
Tab ULTRACET 1/2 tab QID 1/2 - 1/2 - 1/2 - 1/2
Expected discharge summary:-
A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.
History of present illness:
The patient was apparently asymptomatic 10 years back following which she was diagnosed with DM2 on checkup and on Teneligliptin 20 mg. In 2019 ( 2 years ago) she developed fever, shortness of breath and pedal edema and diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions)
Now presented with history of fever, high grade since 10 days, not associated with vomiting and loose stools . Patient complaints pedal edema bilateral and pitting type, with decreased urine output and burning micturition.
History of past illness:
Outside reports suggest acute kidney injury. Known case of diabetes mellitus since 10 years and on tab Teneligliptin 20 mg and not known case of hypertension, bronchial asthma, tuberculosis.
Personal history:
Married
Mixed diet
Noamal Appetite
Adequate sleep
Bowel movement is regular
Decreased urine output and burning micturition
With no known allergies.
Consumes alcohol occasionally.
Family history:
No significant family history
General examination:
There is Pallor
There is no Icterus, cyanosis, clubbing
Generalized Lymphadenopathy
Edema is seen bilaterally witch is Pitting type pedal edema.
Vitals:
Temperature afebrile
Pulse rate is 111 beats per minute
Respiratory rate is 16 breaths per minute
Blood pressure measured on the left hand is 170/110 mm of Hg
Oxygen saturation at room air is 90 arm per mm Hg
Systemic examination:
Abdominal system:
No scars, sinuses, or any engorged veins.
Hernial orifices intact
Tenderness or guarding absent
No enlargement of liver, kidneys, or spleen
No ascites
Bowel sounds were normal.
Cardiovascular system:
cardiac sounds s1 and s2 heard normally
Apex beat located in 5th ICS, medial to the mid-clavicular line.
No cardiac murmurs
Thrills absent
Respiratory system:
No chest wall deformity
Trachea central
Expansion is symmetrical
Percussion note is resonant
Breath sounds normal, no wheeze or crackles heard.
Vocal resonance normal and symmetrical
Central nervous system:
No focal abnormality detected
Higher mental functions intact
Cranial nerves intact
Speech normal
Provisional diagnosis:
Acute kidney injury secondary to urosepsis
Course in the hospital:-
Day 1:-
Treatment:
Inj LASIX 40mg (8am- 2pm -8pm)
IVF - NS @ UO + 50 ml/hr
Day 2:-
Inj LASIX 40 mg IV/TID 1 -1 - 1
IVF - NS @ UO + 50 ml/hr
Inj MAGNEXFORTE 1.5 gm/IV/BD
Tab NODOSIS - XT PO/OD
Inj HAI s/c
Neb plain Asthalin 4 respules [ 1 - 1 - 1 - 1 ]
Day 2:-
same treatment was continued
Tab OROFEA - XT PO/OD
Strict I/O charting was advised
Day 3:-same treatment was continued
Tab ULTRACET 1/2 tab QID [ 1/2 - 1/2 - 1/2 - 1/2 ] was added.
Day 4 and day 5:-same treatment was continued
Day 6:-
Same treatment was continued
Tab Norflox 200 mg PO/OD was added
Day 7:-
Same treatment was continued
Tab SHELCAL-CT PO/OD was added
Day 8:-same treatment was continued
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