Case 1
This is an online e logbook to discuss our patients de-identified health data shared after taking his/her/their guardian's signed informed consent.
Here we discuss our individual patient problems through a series of inputs from an available global online community of experts to solve those patients' clinical problems with collective current best evidence-based inputs.
Date of admission- 16/08/2021
A 70-year-old man, who is a farm worker by occupation, presented to the hospital with
- Pain in the epigastric region since 4 days
- Constipation since 4 days
- Burning micturition since 10 days
- Decreased urine output since 10 days
- Shortness of breath and swelling in feet since 1 month
- Backpain and fever since 2 months
HISTORY OF PRESENT ILLNESS
- Patient was apparently asymptomatic 4 years ago and then developed cough, fever, swelling in the legs for which he visited a local hospital where he was diagnosed with Chronic Renal Failure
- Referred to current hospital for treatment for CRF 4 years ago and was on medication for 1 year which he discontinued after his symptoms got better
- Patient had pain in the back 3 years ago which subsided on taking painkillers prescribed by local RMP
- His attendant has mentioned that the patient took the same painkillers liberally over the past 2 years whenever he felt pain in the back
- Patient continued his smoking and drinking habit 3 months ago
- Backpain and fever since 2 months
- 1 month ago, he started experiencing shortness of breath, cough with sputum and pedal edema
- Burning micturition and decreased urine output since 10 days
- Pain in the epigastric region since 4 days
PAST HISTORY
- Known case of hypertension since 1 year
- Patient is a known case of Chronic Renal Failure since 4 years
- Patient was suffering from Tuberculosis infection 20 years ago
- Not a known case of Diabetes mellitus, Asthma, Epilepsy
PERSONAL HISTORY
-Mixed diet of veg and non-veg food
-Appetite Inadequate
-Bowel movements- decreased- once in 2-3 days
-Decreased urine output with burning micturition since 10 days
-Patient is an alcoholic since the age of 20 years
-Chronic smoker (4-5 chutta/day) since the age of 15 years
-Patient stopped smoking and drinking 4 years ago
-Patient started drinking and smoking again 3 months ago
TREATMENT HISTORY
-Patient is on antihypertensives since 1 year
-Patient took painkillers liberally over the span of 2 years whenever he felt pain and discomfort especially in the neck and back area
GENERAL EXAMINATION
- Patient is conscious, coherent and cooperative
- Pallor- Yes
- Cyanosis- No
- Lymphadenopathy- No
- Clubbing of fingers- No
- Bipedal pitting edema
Shape of abdomen- Scaphoid
No tenderness
Vitals
Temperature- 98.6 F
Pulse rate- 82 BPM
S1 and S2 heard
spO2- 94
BP- 120/70
S1 and S2 heard
PROVISIONAL DIAGNOSIS
Chronic Renal Failure (?Analgesic Nephropathy)
?COPD
?Viral Thrombocytopenia
INVESTIGATIONS
16/08/2021
17/08/2021
18/08/2021
19/08/2021
20/08/2021
ULTRASOUND
TREATMENT
DAY 1
Fluid retention <2L/day
Salt retention <2L/day
INJ Lasix 40mg/ IV TID
TAB Nodosis 500mg/PO/TID
TAB Shelcal 500mg/PO/OD
TAB Amlong 5mg/PO/OD
TAB Orofer- XT PO/OD
Neb Duolin- 8th hourly
Neb Budecor- 12th hourly
Strict I/O charting
GRBS 8th hourly
Monitor vitals 8th hourly
DAY 2
INJ Lasix 40mg/ IV TID
TAB Nodosis 500mg/PO/TID
TAB Shelcal 500mg/PO/OD
TAB Amlong 5mg/PO/OD
TAB Orofer- XT PO/OD
Neb Duolin- 8th hourly
Neb Budecor- 12th hourly
Strict I/O charting
GRBS 8th hourly
Monitor vitals 8th hourly
DAY 3
Haemodialysis for 2 hours
INJ Tranexa 1amp/ IV/ STAT
INJ NaHCO3 100 meq in 200ml NS/IV/STAT
INJ 3% NaCl infusion at 10ml/hr for 4 hours
Fluid retention <1.5 L/day
DAY 4
Fluid retention <1.5 L/day
INJ Lasix 40mg/ IV TID
NJ Ceftriaxone 1g/IV/BD
INJ Pan 40mg/ IV/OD
TAB Nodosis 500mg/PO/TID
TAB Orofer- XT PO/OD
TAB Amlong 5mg/PO/OD
Neb Ipravent- 8th hourly
DAY 5
Fluid retention <1.5 L/day
INJ Ceftriaxone 1g/IV/BD
INJ Pan 40mg/ IV/OD
TAB Nodosis 500mg/PO/TID
TAB Orofer- XT PO/OD
TAB Amlong 5mg/PO/OD
Neb Ipravent- 8th hourly
Neb Budecor- 12th hourly
GRBS 8th hourly
Monitor vitals 4th hourly
DISCUSSION
1) What could be the possible reason for patient's kidney failure and probable COPD?
2) What is the effect of chronic abuse of NSAIDs on kidneys?
3) What could be the probable cause of thrombocytopenia in this case?
Comments
Post a Comment