38year woman With CKD

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38 year old woman  currently on hemodialysis in our hospital for renal failure. 
She presented to our hospital 1 month back with the complains of :
      Dypnea at rest since 5 days
      Bilateral pedal edema since 4 days

She tells me that she has been feeling depression ever since her mother passed away in `1995 due to a medical condition ( reason not known )  who was apparently a known diabetic and a known hypertensive. In 1998, her father passed away because of an unknown cardiac condition. She got married in 2000 to her husband who works at a rice mill industry and owns a Pharmacy store. She has 2 daughters, the elder daughter is 19yrs of age and currently in her Btech 2nd year, 2nd daughter is 17yrs old and is in her inter 2nd year. 
In 2006 she paid a visit to her dentist for getting a  rootcanal done that was when she got diagnosed with type 2 diabetes mellitus and was put on Tab Zoryl 2mg BD. She has been switching from Tab Zoryl 2mg to 1mg depending on her blood sugar levels on her own . 
6 yrs back, her husband had to sell their pharmacy store because of road construction work, since then her husband says she has been more stressed and she would randomly throw tantrums. It had got to such a point that she would throw objects aggressively at others and over the past 5 years she has also been having visual and auditory hallucinations. She was taken to a psychiatrist  and the doctor there started her on tab Sizodon Forte ( risperidone and trihexyphenydryl ) and Tab Dayo 250mg ( Divalproex) and they even consulted a neurophysician who advised for a CT brain which turned out to be normal. She got diagnosed to be a hypertensive 3 yrs back and has been using Tab metxl 25mg once daily on and off since then. 
One and a half years back she consulted an obstetrician since she had amenorrhea since 3 months, her husband says that he even found her to be pale then and on routine investigations she got diagnosed with renal failure with a serum creatinine of 5mg/dl and Sr urea of 70mg/dl and her Ultrasonography of Abdomen showed normal sized kidneys with Grade 3 RPD changes for which they consulted a nephrologist who started her on sodium bicarbonate and calcium supplements. 
1 month back she presented to our hospital dyspneic with bilateral pedal edema extending to her thighs, her Serum creatinine was 9 mg/dl at this point and she was taken up for hemodialysis.
She is obese and appeared to be pale.



With Ecchymosis on her left forearm


On examination 

CVS - S1,S2 +
Lungs - Bilateral inspiratory crackles  in all the lung fields
P/A - Distended
          Non tender
       TEMPERATURE CHART WITH TOTAL LEUKOCYTE COUNT



She has been having temperature spikes since the past 20 days and has also been giving a history of dry cough since 3 months.
The past 3 days she has been complaining of productive cough with scanty, mucoid sputum.

Her Serial Chest X rays

                                    15/7/2020


17/7/2020



                              18/7/2020


                                   20//7/2020




2DECHO







 Her HRCT CHEST shows 

Right lower lobe consolidation
Bilateral lung cavities













CT Abdomen shows hepatomegaly



Her sputum was sent for CBNAAT which turned out to be negative.

She is currently on
Inj Meropenem, 
Inj Lasix 40 mg TID
Tab Sodium Bicarbonate
Tab Nicardia 10mg TID
Inj Human Actrapid Insulin 

Comments

  1. NamJuly 31, 2020 at 4:10 AM

    Very well written thank you for sharing. What were the ecg findings?

    ReplyDelete

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