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PRE -RENAL AKI 2° to DEHYDRATION with HYPOVOLEMIC SHOCK with ALCOHOLIC KETOACIDOSIS with WERNICKES ENCEPHALOPATHY with ACUTE HEART FAILURE with EF-45% with REFRACTORY METABOLIC ACIDOSIS with H/O PULMONARY KOCH'S (3Y BACK) with K/C/O ASTHMA (4Y BACK) with K/C/O DM(6Y BACK)

- October 22, 2021

55 YEAR OLD FEMALE CAME TO THE CASUALTY WITH 

c/o shortness of breath since 4 days

 ( grade 4 ) acc to NYHA classification not associated with orthopnea /PND 

c/o vomiting since 1 day (5-6 episodes ) non projectile,non bilious ,food particles as content associated with pain abdomen 

c/o fever since 2 days ,low grade,not associated with chills and rigor 

c/o decreased appetite since 3 days 

H/O drinking alcohol since last 10 days without eating anything else

K/C/O Asthma since 4 years  

H/O Pulmonary kochs 3 years back used ATT for 6 months 

K/C/O DM since 6 years on TAB. GLIMI-M2

O/E:

Vitals on Admission

BP-Not recordable 

PR- 121 BPM 

RR-22 CPM 

SPO2-98 @

GRBS -254

No pallor Icterus cyanosis clubbing lymphaedonopathy and oedema 

CVS: S1S2 heard ,no thrills ,no murmers

RR: Dyspnoea present 

      No wheeze 

       BAE positive ,NVBS

 

P/A: soft ,non tender

         BS- sluggish 

On admission

Ur : 63

Cr:1.9

UA:4.9

SERUM ELECTROLYTE 

Na-138

K-4

Cl-98

Aftr 1 session of dialysis (7pm)

Ur : 93

Cr:3.2

UA:3.9

SERUM ELECTROLYTE 

Na-134

K-3.9

Cl-98

post dialysis ( next morning)

Ur : 83

Cr:3.1

UA:3.9

SERUM ELECTROLYTE 

Na-134

K-3.9

Cl-98

on 26/10/21

Ur : 152

Cr:4.9

UA:5.8

ca-7

SERUM ELECTROLYTE 

Na-135

K-3.9

Cl-106

abg on 26/10/21

ph-7.249

pco2-28.4

po2-152

Amylase 46

Lipase 24

PROVISIONAL DIAGNOSIS:

PRE -RENAL AKI (RESOLVING) 2° to DEHYDRATION with HYPOVOLEMIC SHOCK with 

ALCOHOLIC KETOACIDOSIS (RESOLVED) with WERNICKES ENCEPHALOPATHY (RESOLVING) with 

ACUTE HEART FAILURE with EF-45% with REFRACTORY METABOLIC ACIDOSIS (RESOLVING)

with H/O PULMONARY KOCH'S (3Y BACK) with 

K/C/O ASTHMA (4Y BACK) with K/C/O DM(6Y BACK)

TREATMENT

IVF 4 NS - bolus 

Inj Nor adrenaline 8ml/hr ( 2amp in 47 ml NS)

IVF NS,RL @ 100 ml /hr continuos 

Inj Sodium Bicarbonate 100meq /iv/ stat - 50 meq in 100 ml NS /IV / slow infusion over 2 hours 

Inj PANTOP 40 mg /iv /od 

Inj neomol 100ml /sos 

Inj ZOFER 4mg /IV / OD 

Inj Ceftriaxone 1 gm /iv/ bd 

Inj HAI (39 ml NS with 40 IU HAI ) 

Inj Sodium Bicarbonate 1 amp in 100 ml NS /Stat 

Inj Piptaz 4.5 gm /IV/Stat- Inj Piptaz 2.25 gm /IV / TID