69 year old female with Dengue with AKI with hyperkalemia and Metabolic acidosis(resolved)

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Here is a case i have seen:

69year old female Came with c/o fever since 1 week Not associated with chills and rigors

H/o 1 episode of giddiness

No h/o nausea, vomitings, loose stools, pain Abdomen, rashes, bleeding gums

Pt was apparently asymptomatic one week back then she developed loss of appetite and fever for which she went to local RMP took some medications(no records available), and then they took the pt to **** hospital and she was put on inj piptaz and IV fluids and was diagnosed with decreasing platelets, High creatinine and was admitted in ICU for 5 to 6days( till today MORNING), and was reffred to our hospital for further management

Outside reports

on 18/9/20

Dengue NS 1 positive

IgM weakly positive 

IgG negative

on 19/9/20

hb 10.5,TLC 9,600,plt 20,000

RBS 90,serum creat 5.3,urea 52,Na 141,K 4.7,cl 102,TB:1.0,DB 0.7,IB 0.3,SGOT 28,SGPT 31,ALP 97,TP 7.0,alb 4.2

On 20/9/20 CbP 11.3,TLC 13,400,plt 49000

Serum creat 6.1

H/o decreased urine output(noticed in hospital) 

H/o Black tarry stools was noticed by pt attendors while changing the diaper, no h/o other bleeding manifestations

No h/o SOB

Not a K/C/O DM, HTN, CVA, CAD, thyroid disorder

O/E pt conscious coherent

PR 64

Bp 90/60(no postural drop)

RR 16/min

Cvs s1 s2 +, no murmurs

RS BAE +, NVBS

P/A soft, NT

CNS no FND

Hb11. 4

Tlc 12,000

Plt 50,000

UREA 211

Creat 6.7

Ca 9

Na 135

K 6.4(salbutamol neb, inj calcium gluconate, inj Hai 12units in  25D given) - - >after 1hr K :4.4

Cl 113

Smear for Mp negative

Bgt B positive

Pt 16sec

INR 1.1

ApTt 31sec

RBs 82

CUE:

Alb trace

Pus cells 3 to 4

Rbc nil

Sugar nil

TB 1.28

DB 0.50

SGOT 56

SGPT 43

ALP 179

Alb 2.9

ABG 

Ph 7.31

Pco2 23

Po2 101

Hco3 11.4

Sp O2 94%

Urinary electrolytes

Na 354

K 14.1

Cl 360

Spot urine protein 19.4

Spot urine creat 81

Ratio 4.17

Hiv HbsAG Hcv negative

USG abdomen: B/L grade 3 rpd changes, b/L simple renal cysts, mild ascites, free fluid notes in Morrisons pouch and interbowel space, 

IVC max dia 9mm,min dia 5mm

Hrct chest:

Patchy ground glass opacities in superior segment of rt lower lobe

Areas of bronchiectasis rt middle lobe

B/L mild pleural effusion

Corads 3

CT severity score 2/25

ecg:

? Dengue (outside NS 1positive)with? prerenal AKI with Hyperkalemia and metabolic acidosis

Day 2:

No fever spikes no fresh complaints

O/E pt conscious coherent

PR 80bpm

Bp 110/70mmhg(no postural drop) 

RR 16/min

Cvs s1 s2 +, no murmurs

RS BAE +, NVBS

P/A soft, NT

CNS no FND

Grbs:110mgdl

I/O:1200/1750ml

Reports:

ABG 

Ph 7.26

Pco2 26.3

Po2 98.5

Hco3 11.6

Sp O2 94%

Hb 9.5

Tlc 12,500

Plt 50,000

UREA 173

Creat 5.6

Ca 8.2

Na 137

k 4.9

Rx:

1.plenty of oral fluids upto 3L/day

2.iv fluids

3.inj.pantop 40mg/iv/od

4.inj.zofer 4mg/iv/bd

5.tab.pcm 650mg/po/sos

6.inj.lasix 20mg/iv/bd

day 3:

No fever spikes no fresh complaints

O/E pt conscious coherent

PR 80bpm

Bp 110/70mmhg(no postural drop)

RR 16/min

Cvs s1 s2 +, no murmurs

RS BAE +, NVBS

P/A soft, NT

CNS no FND

Rx:

1.plenty of oral fluids upto 3L/day

2.iv fluids

3.inj.pantop 40mg/iv/od

4.inj.zofer 4mg/iv/bd

5.tab.pcm 650mg/po/sos

6.inj.lasix 20mg/iv/bd

day 4

No fever spikes

No c/o bleeding gums, hematemisis, malena

O/E pt c/c

PR 80/min

BP 100/70

Cvs s1 s2 +, no murmurs

RS BAE+

P/A soft, Non tender

I/O 2900/3000

Grbs 108

Reports:

HB 11.2

Tlc 8000

Plt 60,000

Na 132

K 4.3

Cl 91

Urea 136

Creat 5.3

Ph 7.435

Pco2 18.4

Hco3 12.2

St Hco3 15.9

Po2 94.2

2d echo  ef 58%,diastolic dysfunction +, good LV function

24 urinary protein creatinine report

Rx:

1.plenty of oral fluids upto 3L/day

2.iv fluids

3.inj.pantop 40mg/iv/od

4.inj.zofer 4mg/iv/bd

5.tab.pcm 650mg/po/sos

6.inj.lasix 20mg/iv/bd

day 5

Loose stools - 3 episodes, watery in consistency 

Decreased appetite 

No fever spikes

O/E pt c/c

PR 92/min

BP 100/70 mmHg(no postural drop)

Cvs s1 s2 +, no murmurs

RS BAE+

P/A soft, Non tender

I/O - 2200/900 ml

Grbs -  89mg/dl

CBP on 25/9

HB - 11 

Tlc -  9800 cells/cumm

Plt 50,000

Na 137

K 5.9

Cl 103

Urea 112

Creat 5.5

Rx:

1.plenty of oral fluids upto 3L/day

2.iv fluids

3.inj.pantop 40mg/iv/od

4.inj.zofer 4mg/iv/bd

5.tab.pcm 650mg/po/sos

6.inj.lasix 20mg/iv/bd

day 6

No fresh complaints

O/E pt c/c

PR 90/min

BP 100/70 mmHg(no postural drop)

Cvs s1 s2 +, no murmurs

RS BAE+

P/A soft, Non tender

Grbs -  94mg/dl

CBP on 26/9

HB - 10.4

Tlc -  7600cells/cumm

Plt- 1lakh/cumm

Na 140

K 3.7

Cl 103

Urea 91

Creat 3.8

Rx:

1.plenty of oral fluids upto 3L/day

2.iv fluids

3.inj.pantop 40mg/iv/od

4.inj.zofer 4mg/iv/bd

5.tab.pcm 650mg/po/sos

6.inj.lasix 20mg/iv/bd