A 62 yr old female with anuria

 This is online E-blog, to discuss our patient de-identified health data shared after taking her guardian's signed informed consent.

Here we discuss our individual patient problems through series of inputs from  available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.

This E-blog also reflects my patient's centred online learning portfolio.

I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

C/o

Patient was brought to casualty in confuse state GCS at time of admission E3 V5M4 

patient was  lying confused at time of presentation 

known case of hypertension since two years 

history of polyarthritis since one month 

HOPI 

Patient was apparently a symptomatic two days ago then he developed anuria 

On next day he complained of giddiness and patient slept after about 30 minutes patient attenders found her unresponsive and took her to a local hospital and patient was intubated and connect to mechanical ventilation in view of low GCS

CT brain was done -age related mild cerebral atrophy changes with chronic ischaemic changes .at around 6 PM two days ago patient regained consciousness patient was been off the ventilator and on T piece came Lama from there.

Patient had hypotension during outside hospital stay

 and  kept on  noradrenaline,vasopressin and treated with meropenam, injection hydrocortisone, injection sodium HCO3 and doxycycline 

patient attenders complained of decreased urine output after the admission at outside hospital based on foleys  urobag  output

K/c/o HTN since 2 yrs

N/K/C/O DM,BA,TB,CVD

GENERAL EXAMINATION 

No pallor, No icterus, No Cyanosis, No Lymphadenopathy, No Edema

VITALS

Temperature -98F

Pulse rate- 98bpm

Blood pressure-90/60mm hg

Respiratory rate -24cpm

Spo2-96% on 4 lit of O2 on T piece

SYSTEMATIC EXAMINATION:

PER ABDOMEN:Soft, non tender

No guarding, No rigidity 

Bowel sounds present 

CARDIOVASCULAR SYSTEM:

S1,S2 heard, NO Murmurs 

RESPIRATORY SYSTEM:

BAE present,NVBS

CENTRAL NERVOUS SYSTEM:

NAD

PROVISIONAL DIAGNOSIS-AKI ON CKD

TREATMENT 

1.INJ MONOCEF  1gm IV BD

2.INJ PAN 40mg IV OD

3.NEBULISATION WITH DUOLIN AND BUDECORT 8th hourly

4.TAB NODOSIS 500mgPO BD

5.TAB SHELCAL 500mg PO OD

6.TAB BIO D3 weekly once

7.INJ EPO 4000IU weekly once

8.INJ LASIX 20 mg IV BD