85 yr old male with sob and pedal edema


85 yr old male was brought to casualty with 
c/o: SOB since 4days(grade 2-3),pedal edema since 4 days,decreased urine output since 4 days,h/o low grade  fever, cough(with sputum) since 4 days,

HOPI:pt was apparently asymptomatic 5 days back then he developed,B/L pedal  edema,decreased urine output,anuria since morning,low grade fever with cough(with sputum),sob (grade 2-3).

PAST H/O: 3 yrs ago h/o RTA,injury to L fore arm,operated ?I.M nail was put and removed after 3 months.
pt used NSAID's continuously for L hand pain for almost 6 months daily.c/o pedal edema 6 months ago,creatinine was around 3.5-4 treatedwith medication,pedal edema subsided.pt continued to useNSAID's from local RMP.
2 yrs ago h/o SOB,pedal edema admitted in hospital and blood transfusion was done.
N/K/C/O DM,HTN.
GENERAL EXAMONATION:
BP-140/90 mmhg
PR-18/m
RR-96/m
CVS-S1S2 +
RS-BAE+,Diffuse wheeze+, Rt IMA,ICA crepts +,decreased breath sounds B/L.
INVESTIGATIONS
Reports on 4th april


DIAGNOSIS:AKI on CKD secondary to Right middle lobe consolidation.
CKD secondary to NSAID abuse.
Malunited left forearm fracture.

TREATEMENT:
Inj.LASIX 40mg IV TID
Inj.MONOCEF 1gm IV BD
Neb.DUOLIN,BUDECORT inh TID
O2 INHALATION 2lit
Inj.PAN40 IV OD
salt restriction
Tab.NODOSIS 500mg PO TID
Tab.OROFER XT PO OD
Cap BIOD3 weekly once
syp.ASCORYL-LS 10ml PO TID

before 1st dialysis on day of admission(4th april)
urea-177mg/dl
creatinine-14.5mg/dl
phosphorus-6.9mg/dl
calcium-10.2mg/dl
sodium-137mEq/L
potassium-5.7mEq/L
chloride-105mEq/L

after 1st dialysis(on 5th april)



urea-108mg/dl
creatinine-9.5mg/dl

2nd dialysis was done on 6th april
after dialysis urea-38mg/dl
creatinine-4.5mg/dl 
phosphorus-3.6mg/dl
calcium-10 mg/dl
sodium-145mEq/L
potassium-4 mEq/L
chloride-102mEq/L
hb-6.7mg/dl
Tlc-14400c/cumm

Reports on7th april

on 7th evening

pt suddenly had 
fever spike of 101 F
tachypnea(RR-30)
HR-126/m
spO2-95 on 6 litres of O2
having wheeze in all areas not decreasing with nebulisation(ipravent+budecort).
ABG-pH-7.40
pco2-42.9
po2-56.7
Hco3-26.3
3rd dialysis was done on 7th april(evening)
reports after dialysis


4th dialysis was done on 8th april(evening)
reports after dialysis










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