raja kumari.pptx 123674884894949499484848

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1. CONTINUOUS QUALITY IMPROVEMENT DURATION OF STAY – 24hours PRESENT ATOR – Dr. P.Kalyan 1st year Post G raduate Department of General Medicine

2. CHIEF COMPLAINTS A 50 year old female presented to ER with the chief complaints of Shortness of breath sin ce 3days Decreased urine output from 6hours

3. HISTORY OF PRESENT ILLNESS Patient was apparently normal 3days back after which present complaint started as Complaints of SOB, insidious progressive from grade 2 to grade 4 , no orthopnea , no PND Complaints of decreased urine output from 6hours not associated with pain abdomen and abdominal distension

4. No complaints of vomiting and loose stools No complaints of chest pain , cough , hemoptysis . No complaints of blurring of vision, involuntary movements and headache , reeling sensation

5. PAST HISTORY No History of similar complaints in the past. K/c/o diabetic and hypertensive No history of CVA , CAD , Pulmonary TB , Epilepsy and bronchial asthma No H/o blood transfusion
No H/o surgeries in the past K/c/o CKD not on hemodialysis

6. PERSONAL HISTORY Mixed diet Regular bowel and bladder habits Not a smoker , alcoholic Family history - Nil significant

7. General condition on examination Patient is altered and disoriented Moderately built and nourished . pallor + No icterus No cyanosis No clubbing No lymphadenopathy edema +

8. Vitals at the time of presentation BP- 200/100 mmhg PR- 107 /min RR- 42 /min SPO2- 77 % @RA . 87 %on fio2 90% peep 5cm H20 Temp-afebrile

9. Systemic Examination Inspection Shape of the chest is elliptical Shape of the spine is normal. Trachea appears to be in midline. Movements of the chest are bilaterally symmetrical during respiration in all regions. No visible pulsations or discharging sinuses or scars.

10. Palpation Trachea is in midline Apex beat palpable at half inch medial to the mid clavicular line in the left fifth intercostal space. Respiratory movements are bilaterally symmetrical in all the areas. No tenderness or rib crowding.

11. Percussion Resonant note heard in all areas Auscultation B/l NVBS Diffuse crepts present

12. CVS S1,S2 heard No murmurs P/A S oft ,non tender No organomegaly Bowel sounds present CNS B/L Pupils- B/L NSRL Plantars – B/L flexors

13. Provisional diagnosis ACUTE ON CHRONIC KIDNEY DISEASE WITH SEVERE METABOLIC ACIDOSIS WITH K/C/O HYPERTENSION AND DIABETIC

14. Investigations at admission

15. CBP 25 / 7 /24 26 / 7 /24 HB 6.8 7.2 WBC 21.3 19.9 DC N 88, L 7 ,E ,M 4, B0 N 91, L 3, E 1 ,M 5 ,B0 Platelets 2.44 lac 2.34lac ESR 107 80 MCV 91.9 91.0 MCH 31.7 21.3 MCHC 3 4.5 31.9 Impression Normocytic normochromic anemia with neutrophilic leucocytosis Normocytic normochromic anemia with neutrophilic leucocytosis

16. RFT 25 / 7 /24 26 / 7 /24 S.Urea 125 105 S.Creatinine 5.4 4.6

17. S.ELECTROLYTES Day1 25 /1/24 Day 2 6 /1/24 Sodium 137 140 Potassium 5.8 6.2 Chloride 10 6 107 Serum calcium 25/7/24 9.2 Phosphorus 25/7/24 6.43 Uric acid 25/7/24 9.0 Hba1c 25/7/24 8.4 TSH 25/7/24 8.99

18. LFT 25 /1/24 20/1/24 23/1/24 25/1/24 Total Bilirubin 0.5 0.5 0.5 0.5 Direct Bilirubin 0. 2 0.3 0.3 0.2 Indirect Bilirubin 0.3 0.2 0.2 0.3 Alkaline phosphatase 7 4 65 58 59 Aspartate Transaminase 24 91 84 86 Alanine Transaminase 38 160 17 158 Total Proteins serum 6.3 5.3 6.2 6.6 Albumin serum 3.9 3.4 3.6 3.9 Globulin serum 2. 4 1.9 2.6 2.7 A/G Ratio 1. 6 :1 1.7:1 1.3:1 1.4:1

19. Complete urine examination Day1 25 /1/24 Day2 25/1/24 PROTIEN negative 2+ Traces Ketones Negative Negative Negative Glucose Negative 3+ Nil Haemoglobin Negative 3+ +

20. Other investigations Dengue(NS1 A g) Negative Leptospira Negative Scrub typhus Negative Smear for MP and MF Negative Viral markers HIV Non-reactive HBsAg Non reactive HCV Non-reactive

21. Hb-a1c 10.0 D-Dimer 23/1/24 0.8 TSH 1.32 Spot urine sodium 130.8 Spot urine potassium 19.47 Spot urine osmalility 272.9