25 yrs old female with aki



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 2 Nov 2022

25 YEAR OLD FEMALE Resident of Nalgonda

Chief Complaints:

Generalized edema  on and off since 2months

Shortness of breath since 1week

Fever since 10 days


History of Presenting Illness:

Patient  G2P1L1 was apparently asymmtomatic 2months back then she developed generalized edema for which she went to local RMP where she was diagnosed as  Gestational Hypertension and started on medication. 1week later she developed seizures 2 episodes - Tongue bite and loss of consciousness present. She went to Yashoda hospital and MRI was done which showed PRES (Posterior Reversible Encephalopathy Syndrome) 2D Echo showed global hypokinesia. LV Dysfunction with 45%Ejection fraction

On 10/10/2022 (30 weeks of gestation) Emergency LSCS was done in view of fetal distress (cord around the neck) 960 gm female child.. In ot she had one episode of seizure for which she was intubated, antihypertensive, antiepileptics, laxics, blood transfusion done. One week later she was discharged as LAMA. She went to hospital in Nalgonda on 16/10/2022 when she had pedal edema where they found out deranged LFT and RFT, Dialysis was advised, her haemoglobin was 7gm/dl so blood transfusion was given. She went to another hospital with complaint of pedal edema, oliguria, facial puffiness - 3sessions of hemodialysis done and 2 blood transfusion.

Later she developed Shortness of breath grade 2 insidious in onset aggravated on lying down. Fever high grade not associated with chills and rigors. Burning micturation. Hemoptysis. 

Complaint of headache during pregnancy


Past History:

No History of Diabetes, Thyroid, Tb , epilepsy, 

No previous operation

Blood transfusion 3 sessions

Previous Pregnancy - Conceived spontaneous. All the trimester uneventful. Normal full term vaginal delivery. Baby Girl (current age 4 years).


Family History:

Elder sister died 3years ago due to seizures


Personal History:

Diet mixed

Appetite Normal

Bowel movement normal

Bladder Burning micturation

No addictions and allergies.


General examination:

Patient is conscious coherent and cooperative, well oriented to time place and person.

Moderately built and nourished.

Pallor present

Bilateral pedal edema

No Icterus, Clubbing, cyanosis, lymhadenopathy

Vitals:

Temperature Afebrile

BP 120/80 mmHg

Pulse rate 88bpm

Respiratory rate 18cpm


Systemic examination:

Respiratory system

Shape of chest elliptical, trachea central

Bilateral equal movements present 

No scars,  sinuses

Normal vesicular breath sounds


Cardiovascular system

JVP elevated

JVP elevated

Apex beat left 5th intercoastal space 

in mid clavicular line

S1, S2 heard, no murmurs.


Per Abdomen 

Shape scaphoid, umbilicus everted

C Section scar present in lower abdomen

Soft no organomegaly

Tender in left iliac fossa

Bowel sounds heard



Central nervous system

Higher mental functions intact

Well oriented to time place and person.

No Focal Neurological Deficit





Investigations:


Anisopoikilocytes,schistocytes, bite cells














Diagnosis:

Gram negative Sepsis

AKI secondary to MODS DIC

Autoimmune condition?

HUS TTP?

PRES (Posterior Reversible Encephalopathy Syndrome) 

HELLP Syndrome ( Hemolysis Elevated Liver enzymes Low  Platelets)

Heart failure secondary to Severe Anaemia.


Rx:


INJ. LASIX 80mg—X—40mg IV BD

INJ. MEROPENEM IV OD

INJ. ZOFER IV TID

T. NICARDIA RETARD 20mg PO TID

T. MET XL 50mg PO BD

T.LEVIPIL 500mg PO BD

T. ECOSPRIN AV 75mg PO OD

T. HYDRALAZINE 12.5mg PO BD

Vitals monitoring 2hrly

Temperature charting 2hrly


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