ACUTE KIDNEY INJURY SECONDARY TO UROSEPSIS

June 19, 2021

A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.

History of present illness:

The patient was apparently asymptomatic 10years back following which she was diagnosed with DM2 on checkup and on Teneligliptin 20 mg. In 2019 ( 2 years ago) she developed fever, shortness of breath and pedal edema and diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions)

Now presented with history of fever, high grade since 10 days, not associated with vomiting and loose stools . Patient complaints pedal edema bilateral and pitting type, with decreased urine output and burning micturition.

History of past illness:

Outside reports suggest acute kidney injury. Known case of diabetes mellitus since 10 years and on tab Teneligliptin 20 mg and not known case of hypertension, bronchial asthma, tuberculosis.

Personal history:

Married 

Mixed diet

Normal Apetite 

Adequate sleep

Bowel movement is regular

Decreased urine output and burning micturition

With no known allergies.

Consumes alcohol occasionally.

Family history:

No significant family history

General examination:

There is Pallor 

There is no Icterus, cyanosis, clubbing

Generalized Lymphadenopathy

Edema is seen bilaterally witch is Pitting type pedal edema. 

Vitals:

Temperature afebrile

Pulse rate is 111 beats per minute

Respiratory rate is 24 cycles per minute

Blood pressure measured on the left hand is 170/110 mm of Hg

Oxygen saturation at room air is 90 arm per mm Hg

Systemic examination:

Abdominal system:

No scars, sinuses, or any engorged veins.

Hernial orifices intact

Tenderness or guarding absent

No enlargement of liver, kidneys, or spleen

No ascites

Bowel sounds were normal.

Cardiovascular system:

cardiac sounds S1 S2 heard.

No cardiac murmurs

Thrills absent

Respiratory system:

No chest wall deformity 

Trachea central

Expansion is symmetrical

Percussion note is resonant

Breath sounds normal, no wheeze or crackles heard.

Vocal resonance normal and symmetrical

Central nervous system:

No focal abnormality detected

Higher mental functions intact 

Cranial nerves intact 

reflxes normal

Speech normal

Provisional diagnosis:

Acute kidney injury secondary to urosepsis

Investigations ordered:

14/06/21

1. Complete urine examination: 

2. ECG:

15/06/21:

1. Serum creatinine:

2. Blood sugar Fasting:

3. Blood sugar Random:

4. Blood Urea:

5. Serum Electrolytes:

6. Serum Potassium:

7. Urinary Chloride:

8 URINARY POTASSIUM

9. Urinary Sodium:

16/06/21

1. Serum Electrolytes:

2. Serum Creatinine:

3. Haemogram:





4. Blood urea:





5. ABG:





18/6/21


1. Serum creatinine:





2. Serum Electrolytes:





3.Haemogram:





4.Blood urea:





21/6/21


1. Complete Blood Picture (CBP)





Blood urea:




15/6/21 - 65 mg/dl


16/6/21 - 62 mg/dl


18/6/21 - 76 mg/dl


21/6/21 - 81mg/dl




Serum creatinine:




15/6/21 - 3.4 mg/dl


16/6/21 - 3.4 mg/dl


18/6/21 - 3.2 mg/dl


21/6/21 - 3.1 mg/dl




Total leukocytes count:




16/6/21 - 24700


18/6/21 - 26500


21/6/21 - 31700




Serum Electrolytes:




15/6/21 - Na: 139 ; K: 5.2 ; Cl: 106


16/6/21 - Na: 138 ; K: 5.1 ; Cl: 105


18/6/21 - Na: 136 ; K: 4.9 ; Cl: 102


21/6/21 - Na: 134 ; K: 5.5 ; Cl: 98




Diagnosis:




Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)


With anenmia of chronic disease 




Treatment:




15/06/21:




Treatment:


Inj LASIX 40mg (8am- 2pm -8pm)


IVF - NS @ UO + 50 ml/hr






15/6/21, 5:30 p.m.




Treatment:


Inj LASIX 40mg (8am -2pm -8pm)


IVF - NS @ UO + 50 ml/hr






16/6/21




Treatment:


 Inj LASIX 40 mg IV/TID 1 -1 - 1


 IVF - NS @ UO + 50 ml/hr


 Inj MAGNEXFORTE 1.5 gm/IV/BD


 Tab NODOSIS - XT PO/OD


 Inj HAI s/c


 Neb plain Asthalin 4 respules 1 - 1 - 1 - 1






17/6/21




Treatment:


 Inj LASIX 40 mg IV/TID 1 -1 - 1


 IVF - NS @ UO + 50 ml/hr


 Inj MAGNEXFORTE 1.5 gm/IV/BD


 Tab NODOSIS - XT PO/OD


 Tab OROFEA - XT PO/OD


 Inj HAI s/c


 Neb plain Asthalin 2 respules


 Strict I/O charting






18/6/21




Treatment:


 Inj LASIX 40 mg IV/TID 1 -1 - 1


 IVF - NS @ UO + 50 ml/hr


 Inj MAGNEXFORTE 1.5 gm/IV/BD


 Tab NODOSIS - XT PO/OD


 Tab OROFEA - XT PO/OD


 Inj HAI s/c


 Neb plain Asthalin 2 respules QID


 Strict I/O charting


Tab ULTRACET 1/2 tab QID 1/2 - 1/2 - 1/2 - 1/2




19/6/21




Treatment:


 Inj LASIX 40 mg IV/TID 1 -1 - 1


 IVF - NS @ UO + 50 ml/hr


 Inj MAGNEXFORTE 1.5 gm/IV/BD


 Tab NODOSIS - 500 mg PO/OD


 Tab OROFEA - XT PO/OD


 Inj HAI s/c


 Neb plain Asthalin 2 respules QID


 Strict I/O charting


 Tab ULTRACET 1/2 tab QID 1/2 - 1/2 - 1/2 - 1/2


Expected discharge summary:-


A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.




History of present illness:




The patient was apparently asymptomatic 10 years back following which she was diagnosed with DM2 on checkup and on Teneligliptin 20 mg. In 2019 ( 2 years ago) she developed fever, shortness of breath and pedal edema and diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions)




Now presented with history of fever, high grade since 10 days, not associated with vomiting and loose stools . Patient complaints pedal edema bilateral and pitting type, with decreased urine output and burning micturition.




History of past illness:




Outside reports suggest acute kidney injury. Known case of diabetes mellitus since 10 years and on tab Teneligliptin 20 mg and not known case of hypertension, bronchial asthma, tuberculosis.




Personal history:




Married 


Mixed diet


Noamal Appetite 


Adequate sleep


Bowel movement is regular


Decreased urine output and burning micturition


With no known allergies.


Consumes alcohol occasionally.




Family history:




No significant family history




General examination:




There is Pallor 


There is no Icterus, cyanosis, clubbing


Generalized Lymphadenopathy


Edema is seen bilaterally witch is Pitting type pedal edema. 


Vitals:


Temperature afebrile


Pulse rate is 111 beats per minute


Respiratory rate is 16 breaths per minute


Blood pressure measured on the left hand is 170/110 mm of Hg


Oxygen saturation at room air is 90 arm per mm Hg


Systemic examination:




Abdominal system:


No scars, sinuses, or any engorged veins.


Hernial orifices intact


Tenderness or guarding absent


No enlargement of liver, kidneys, or spleen


No ascites


Bowel sounds were normal.


Cardiovascular system:


cardiac sounds s1 and s2 heard normally


Apex beat located in 5th ICS, medial to the mid-clavicular line.


No cardiac murmurs


Thrills absent


Respiratory system:


No chest wall deformity 


Trachea central


Expansion is symmetrical


Percussion note is resonant


Breath sounds normal, no wheeze or crackles heard.


Vocal resonance normal and symmetrical






Central nervous system:


No focal abnormality detected


Higher mental functions intact 


Cranial nerves intact 


Speech normal




Provisional diagnosis:


Acute kidney injury secondary to urosepsis




Course in the hospital:-


Day 1:-


Treatment:


Inj LASIX 40mg (8am- 2pm -8pm)


IVF - NS @ UO + 50 ml/hr






Day 2:-




 Inj LASIX 40 mg IV/TID 1 -1 - 1


 IVF - NS @ UO + 50 ml/hr


 Inj MAGNEXFORTE 1.5 gm/IV/BD


 Tab NODOSIS - XT PO/OD


 Inj HAI s/c


 Neb plain Asthalin 4 respules [ 1 - 1 - 1 - 1 ]






Day 2:-


same treatment was continued


 Tab OROFEA - XT PO/OD


 Strict I/O charting was advised






Day 3:-same treatment was continued


Tab ULTRACET 1/2 tab QID [ 1/2 - 1/2 - 1/2 - 1/2 ] was added.




Day 4 and day 5:-same treatment was continued






Day 6:-


Same treatment was continued


 Tab Norflox 200 mg PO/OD was added




Day 7:-


Same treatment was continued


 Tab SHELCAL-CT PO/OD was added




Day 8:-same treatment was continued

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