45 yr female with anasarca

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Case presentation:

45 yr old lady who is a housewife and

K/C/O DM 2 since 5yrs and HTN since 1yr,she was apparently normal 6months back,used to develop pedal edema on and off aggravates on walking and relieves on taking rest for which she was taken to nalgonda hospital and the doctor had advised her to decrease the fluid intake and gave some medications.It was associated with shortness of breath grade 3.

5days back she had developed pedal edema which got progressed and developed abdominal distension,facial puffiness associated with decreased urine output,sob even at rest and chest pain on right side, non radiating with intermittent palpitations.

pedal edema was pitting type,not associated with fever, burning micturition,hematuria and frothy urine.She was taken to the same doctor and he had referred her to our hospital due to deranged RFT.

DAY1

She came to casualty with pedal edema, distended abdomen,facial puffiness and no urine output since 3days.

personal history-

diet is mixed, appetite-normal, sleep-adequate, bowel-constipation since 3days,anuria since 3days,habbit of tobacco chewing since 8yrs

O/E-

pt is conscious, coherent and cooperative

pallor is present,

no signs of icterus, cyanosis, clubbing,koilonychia and lymphadenopathy.

ulcer noticed on right sole.

vitals-

afebrile

bp-180/80mmhg,

pr-84bpm

rr-13cpm

CVS-S1S2 heard,no murmurs

RS-BAE present,NVBS

P/A- distended,

CNS-

pt is conscious and well oriented to time,place and person

speech-normal

motor and sensory system-normal

cranial nerves - intact

cerebellar functions-normal

investigations ordered on DAY1

provisional diagnosis on admission-

acute kidney injury with metabolic acidosis with ? nephrotic nephritic syndrome with iron deficiency anemia

treatment given-

1.inj.NaHCO3 100 meq/iv/stat in 100 ml NS

2.syp.POTCHOLR 15 ml in one glass water tid

3.w/h all OHA,anti hypertensives

DAY2

pain abdomen and no passage of urine

no suprapubic tenderness

no burning micturition

O/E-

pt is c/c/c

afebrile

bp-130/80mmhg

pr-84bpm

rr-20cpm

CVS-S1S2 heard

RS-BAE present

P/A-distended,non tender

Investigations-

treatment-

1.inj.HAI according to sliding scale

2.t.OROFER xt bd

3.t.PAN 40 mg od

4.inj.LASIX 40 mg iv bd if systolic bp >110mmhg

DAY3-

pt developed severe shortness of breath with metabolic acidosis and refractory anuria with bp-170/90mmhg,central line was placed and dialysis was done in the morning.

ophthalmology referral was taken and moderate hypertensive retinopathic changes were seen.

investigations after dialysis on DAY3-