Acute Kidney Injury

case presentation on Acute Kidney Injury.
AKI is reservisible loss of kidney function which leads to increase in serum creatinine and BUN over the course of hours to weeks.

1. CASE PRESENTATION ON ACUTE KIDNEY INJURY SUBMITTED BY: CH.BINDU MADHAVI III/VI PHARMD Y17PHD0805 DEPARTMENT OF PHARMACY PRACTICE

2. Brief summary about the case: A male patient of age 50 years was admitted in the hospital with C/O mild SOB ,c/o pedal edema, icterus. He is a mixed diet person. His appetite is moderate and bowel habits are regular. The bladder habits were decreased. He was diagnosed as having ACUTE KIDNEY INJURY. Followed by standard treatment the patient was normalized. The above case was presented in the form of SOAP analysis.

3. SUBJECTIVE DATA: A male patient of age 50 years was admitted in the hospital with C/O mild SOB ,c/o pedal edema, icterus. He is a mixed diet person. His appetite is moderate and bowel habits are regular. The bladder habits were decreased.

4. OBJECTIVE DATA: PHYSICAL EXAMINATIONS: Pt- conscious BP- 140/80mmHg PR- 88 beats/min RR- 20 cycles/min Sp - 98% SYSTEMIC EXAMINATIONS: CVS- RS - BA CNS- NFND P/A- soft  

5. Laboratory investigations: Haematology 11/11/19 12/11/19 13/11/19 14/11/19 APTT [27.4-35.8sec] 26.3 sec LYMPHOCYTES [ 20-45%] 11% PROTHROMBIN TEST TIME [10.5-13.1 sec] 15.7 sec WBC [4400-11000] 22200/cu.mm 21000/cu.mm RBC [4.5-6.5 million/cu.mm] 3.81million/cu.mm HAEMOGLOBIN [14-18g/dl ] 10.8g/dl 11.3g/dl 11.8g/dl 12g/dl HAEMATOCRIT [ 42-54%] 31.2% PLATELET [ 1,50,000-4,00,000/cu.mm] 27000/cu.mm 83000/cu.mm RDW [11.6-14%] 14.5%

6. BIOCHEMISTRY 11/11/19 12/11/19 13/11/19 14/11/19 SERUM BILIRUBIN TOTAL [ 0.10-1.20mg/dl] 20.42 mg/dl 24.42 mg/dl 24.39 mg/dl 17.32 mg/dl SERUM BILIRUBIN DIRECT [ 0.00-0.30 mg/dl] 17.92 mg/dl 15.44 mg/dl BILIRUBIN INDIRECT [ 0.10- 0.80mg/dl ] 2.5 mg/dl 1.88mg/dl SERUM SGOT/AST [ 0-40 IU/L ] 46 IU/L SERUM CREATININE [ 0.90- 1.30] 3.5 mg/dl 3.30 mg/dl 2.6 mg/dl 1.90mg/dl

7. OTHER INVESTIGATIONS: ECG: Normal sinus rhythm possible left atrial enlargement non specific ST abnormality abnormal ECG 2D ECHO/COLOR/DOPPLER REPORT: IMPRESSION: mild LV no RWMA of LV Normal LV systolic function Mild MR Mild TR/PAH

8. REAL TIME ULTRASONOGRAPHY OF THE ABDOMEN: IMPRESSION- Mild enlarged bilateral kidneys with grade I parenchymal changes- AKI Minimal ascites Left minimal pleural effusion [right – 13.5×5.7cm & left - 13× 5.1 cm]

9. ASSESSMENT: Based on the subjective and objective data the final diagnosis was found to be ACUTE KIDNEY INJURY DEFINITION: Acute kidney injury (AKI) or acute renal failure (ARF), is commonly defined as an abrupt decline in renal function, clinically manifesting as a reversible acute increase in nitrogen waste products—measured by blood urea nitrogen (BUN) and serum creatinine levels—over the course of hours to weeks.

10. ETIOLOGY:

11. RISK FACTORS:

12. PATHOPHYSIOLOGY:

13. CLINICAL PRESENTATIONS:

14. GOALS: To reduce signs and symptoms using symptomatic therapy To reduce disease progression To prevent further complications To improve the quality of life of patient

15. Drug information: S.NO NAME OF THE DRUG DOSE ROA FREQ DURA CATEGORY INDICATION 1. INJ.MONOCEF (ceftriaxone) 1gm IV BD D1-D4 2 nd generation Cephalosporins Used to treat bacterial infections. 2. INJ.DOXY ( doxycycline) 100 mg IV BD D1-D4 Tetracyclines Used to treat bacterial infections. 3. INJ.AZITHROMYCIN (azithromycin) 500 mg IV OD D1-D4 Macrolide Used to treat bacterial infections. 4. T.PANTOCID (pantoprazole) 40 mg P/O OD D1-D4 Proton pump inhibitor prophylactic 5. T.NEPHYIT 10 mg P/O OD D1-D3 Minerals Used as mineral supplement

16. S.NO NAME OF THE DRUG DOSE ROA FREQ DURA CATEGORY INDICATION 6. INJ.VIT – K (vitamin k) 10mg/ml IV OD D1-D3 Vitamin K supplement Used to treat vitamin K deficiency 7. T.HEPTAGON (Multivitamin) I tab P/O BD D1-D2 Multivitamin Used to treat vitamin deficiency 8. SYP.POTKLOR (KCL) 15 ml P/O TID D1-D4 Potassium supplement Used to treat hypokalaemia 9. NEB DUOLIN (salbutamol+ ipratropium) 2.5+0.5 mg P/N QID D1-D4 adrenoreceptor antagonist anticholinergic Used to treat SOB 10. CAP.UPCOUNT (carica papaya extract) 1 cap P/O OD D2-D4 Platelet booster Used to increase platelets 11. T.UDILIV (ursodeoxycholic acid) 300 mg P/O TID D2-D4 Gall stone dissolving agent Used to treat icterus condition. S.NO NAME OF THE DRUG DOSE ROA FREQ DURA CATEGORY INDICATION 6. INJ.VIT – K (vitamin k) 10mg/ml IV OD D1-D3 Vitamin K supplement Used to treat vitamin K deficiency 7. T.HEPTAGON (Multivitamin) I tab P/O BD D1-D2 Multivitamin Used to treat vitamin deficiency 8. SYP.POTKLOR (KCL) 15 ml P/O TID D1-D4 Potassium supplement Used to treat hypokalaemia 9. NEB DUOLIN (salbutamol+ ipratropium) 2.5+0.5 mg P/N QID D1-D4 Used to treat SOB 10. CAP.UPCOUNT (carica papaya extract) 1 cap P/O OD D2-D4 Platelet booster Used to increase platelets 11. T.UDILIV (ursodeoxycholic acid) 300 mg P/O TID D2-D4 Gall stone dissolving agent Used to treat icterus condition.

17. PATIENT COUNSELLING: ABOUT DISEASE: AKI is a sudden episode of kidney failure or kidney damage that happens with in few hours or few days. ABOUT DRUGS: T. Pantocid - administer early morning 1 hr before meals. T.Udiliv - should be taken with food. Inj.Monocef - Do not mix ceftriaxone in the same injection with other  antibiotics , or with any diluent that contains calcium, including a TPN (total parenteral nutrition) solution. Inj.vitamin k- If this medication is given into a vein, it should be injected very slowly (no more than 1 milligram per minute) to reduce the risk of serious side effects. Cap.Upcount - administer with food.

18. LIFESTYLE MODIFICATIONS: