Case of CKD with acute exacerbation of renal failure.pptx

Case of CKD with acute exacerbation of renal failure

1. CASE PRESENTATION Mahzaib Awaisi ROLL . 92 Manahal Fatima ROLL. 95

2. History!!!

3. Biodata: My Patient Iqra 21 yearrs old, wife of Mr. Hamza resident of Shalimar colony admitted via emergency on 2nd September, 2024.

4. .Patient presented in emergency with complain of Absence of urination (Anuria) for 5 days , diarrhea 3 days ago and Fever for 2 days . Presenting Complain

5. Patient is known case of CKD , She developed anuria 5 days ago. Sudden in onset just after dialysis & is associated with generalized abdominal pain, motion, fever & headache, not associated with any flank pain, no weight loss Diarrhea She developed diarrhea 3 days ago, 5-6 times a day, ometimes black or yellow in colour . History of Presenting Illness Anuria:

6. History of Presenting Illness Fever She developed fever, with rigor & chills acute in onset (just after dialysis) remittent in nature, aggravated by dialysis, relieved by panadol , associated with sweating, headache; not associated with ear discharge, sore throat, cough, pain in flank.

7. Cardiovascular system: Systemic Inquiry She had no complain of breathlessness, swelling of feet, chest pain, palpitations. Respiratory System: She had no complain of cough, mucus in cough, blood in cough, breathlessness, wheezing sound, chest pain. GIT System: She had complain of nausea & vomiting during the dialysis which is green in color, containing food particle &, foul smelling & projectile in nature, She had no complain of abdominal pain difficulty in Swallowing, diarrhea, day blood in vomitus, constipation Urinary System: She had complain of absence of urination nausea & vomiting & complain of pain in flanks, increase urination, frequency of urination, blood in urine, nocturia

8. Nervousness System Systemic Inquiry She had complain of weakness, numbness in arm, headache, nausea & vomiting. She had no complain of tingling, blackout, fits, visual loss, double vision, Skin: She had no complain of rash, itching, coloured spots. Locomoter System: She had no complain of jomt pain, stiffness, swelling, restriction of movement Endocrine System: She had no complain of inc. in appetite, inc. in thirst, weight gain or loss, palpitation.

9. She had urinary bladder stone for which she undergo surgery She undergo C-sections 2 times in hospital. She had no history of chronic illness like Hypertension, diabetes mellitus, IHD, TB Known Patient of CKD and Hep C Menstrual and Obs History : . She doesn't remember age of menarche, had normal menstrual cycle & regular had no complain of dysmonerrha had 2 kids by cessarian section at term, had high blood pressure in the last month of pregnancy during the and preg , for which she take medicine. After birth of 2nd child, she had infusion of 1 pint blood, after birth, she had, bleeding for many months Past History:

10. Treatment History: . She takes panadol whonever she had fever & headache. * She undergone dialysis for almost 3 months & has undergone 23 dialysts till now She is taking Her medicine for hepatitis C for 10 days FAMILY HISTORY There is no history of DM, Hypertension, IHD, Asthma, TB. Her one cousin had CKD and died at age of 18 years. Her aunts had history of arthritis. PERSONAL & SOCIAL HISTORY * Her husband is Rickshaw driver * They own a house of 5 marlas , and a total of 6 people living in that house * She is housewife and is has no history of smoking, drug dependence, alcohol

11. Examination!!!

12. An Sick looking young girl of average height and built, oriented in time, place and person lying in bed with IV line passed in Rt hand, NG tube, foley catheter, Urine bag having vitals: Pulse 104/min BP 80/40 Temperature 99 F RR 25 breath/min On GPE there was mild pallor, in hands, no yellowing of eyes, no engorged neck veins, no edema of legs and feet and Hands. There is no clubbing, cyanosis, koilonychia , heberdens nodes, bouchards nodes, oslers nodes, hand deformity., palmar erythema, dupuytrens contracture, periorbital edema , proptosis , enlarged lymph nodes. dehydration,. Half n Half Nails present General Physical Examination Emergency Care:

13. On Inspection abdomen is sunken, abdomen is moving with respiration, peristalsis and pulsations are not visible, umbilicus is central and round , Trannsverse scar mark below umbilicus of C-section. No striae or prominent veins . hernial orifices intact. On palpation there is no rigidity, tenderness in right hypochindrium , liver palpable 2 fingers below costal margin (span 18cm) ond no mass palpable. On percussion there is no shifting dullness, no fluid thrill On auscultation 5-6 bowel sounds per min and no hepatic, renal and splenic bruit audible GIT Examination

14. Pulse is 104/min regular of high volume and normal character , no radio-femoral delay, vessel wall not palpable BP 80/40 JVP not raised, edema leg and feet not present. On inspection shape of precordium was normal, no scar marks , no pulsation visible over precordium Apex beat is palpable in 5th intercostal space at midclavicular line of tapping in character no other sounds, thrill and heave palpable. On auscultation both heart sounds are of normal intensity, Pan systolic flow murmur present and no added sounds and basal crepitation Cardiovascular System

15. Respiratory rate is 22/min , respiration is abdominothoracic ,. Shape of chest is normal, no deformity, scar or prominent veins or pulsations visible.chest is moving equally on both sides. On palpation Trachea is central, no tenderness, voca fremitus equal on both sides.no sounds palpable. On percussion border of liver is in 5th intercostal space. percussion note is resonant and equal on both sides On auscultation breath sounds are vesicular. there are no added sounds . vocal resonance equal on both sides Respiratory System

16. GCS of Patient is 13/15 (E3M6V4) not fully conscious (Drowsy) . There is no delusions or hallucinations, memory is good. Cranial nerves: All cranial nerves were intact Motor system: bulk, tone Normal power of muscles can’t be assessed Hyporeflexia , with babniski normal CNS Examination:

17. AKI on CKD Septic Ecephalopathy Urosepsis UTI uremia Differential Diagnosis:

18. CBC RPM S/E. Ca, PO4 ABGs USG Abdomen Pelvis CXR Echo- Cardiography eGFR Urine Analysis Investigations: Emergency Care:

19. MANAGEMENT PLAN: DIALYSIS FLUID AND ELECTROLYTE REPLACEMET ANTIBIOTICS Broad spectrum

20. Thank You!