80 YEAR OLD MALE WITH UREMIC ENCEPHALOPATHY, AKI SECONDARY TO BOO(? vesical calculus)

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 December 14, 2021

Patient came to casualty with
 c/o burning micturition since 15 days
 fever since 5 days 
decreased urine output since 4 days, 
sob since 4 days
Hematuria + for 3 days

HOPI :  Patient was apparently normal 8 years back then he had pain abdomen a/w fever and vomitings and diagnosed with ? Liver abscess and needle aspiration was done.
4 years back patient developed a blister over right ankle which ruptured and for ulcer and cellulitis debridement was done. Since 15 days patient had c/o burning micturition associated with fever, nausea, vomitings and treated accordingly. Fever since 4-5 days, intermittent,not a/w chills and rigors.no loose stools
PAST HISTORY : No HTN/DM
                        NON ALCOHOLIC/NON SMOKER

General examination :

Pt is conscious,coherent and cooperative.thin built and malnourished.

No pallor
No icterus
No clubbing
No lymphadenopathy
No edema
 
Vitals :

Temp : Afebrile
BP : 170/90 mm Hg
PR : 118 bpm
RR : 16 cpm
GRBS : 114 mg / dl
SpO2 : 98 % @ RA

Systemic Examination :
CVS : S1S2 + , No murmurs
RS : BAE + , NVBS +
P/A : Soft , Nontender , BS +
CNS : HMF intact

Provisional diagnosis : 

URAEMIC ENCEPHALOPATHY 
POST RENAL AKI SECONDARY TO BOO(? VESICAL CALCULUS)
? CHRONIC CYSTITIS/? PYELONEPHRITIS
PROSTATOMEGALY GRADE 1

Clinical images :



Plan of treatment :
INJ.PCM 1 GM /IV/SOS
INJ.PAN 40MG/IV/SOS
INJ.ZOFER 4MG/IV/TID
IVF NS@UO+30ML/HR
TAB.NICARDIA 10 MG/PO/STAT
BP/PR/TEMP MONITORING 4TH HOURLY
TAB. NODOSIN 500MG/PO/ TID
INJ.PIPTAZ 4.5GM/IV/STAT


                              DAY 2:
S-FEVER WITH CHILLS

O- O/E pt AROUSABLE
*BP-100/60 mm of hg on NA @ 20 ml/hr 
*PR-120 bpm
*spo2-93% 
*cvs-s1,s2 +
*RS-BAE + 
*P/A - soft and non tender 
*CNS-B/L pupils NSRL
E4V15M6


A- UROSEPSIS SEPSIS SECONDARY TO POST RENAL OBSTRUCTION 
POST RENAL AKI SECONDARY TO ? B.O.O
B/L MODERATE HYDROURETERONEPHROIS
VESICLE CALCULUS (5MM)
UREMIC ENCEPHALOPATHY 

1]INJ. MEROPENEM 500mg/IV/BD
      2]INJ.PAN 40
      3]INJ. ZOFER
      4]IVF 1NS , 1RL @50 ML/MIN 
      5]INJ. LASIX 20 
      6]TAB PCM 650 
      7]TAB NODOSIS  500
      8]BP,PR,TEMP MONITORING
      9]RT FEEDS [free water milk + protein 100 ml 4th hourly 
      10]STRICT I/O CHARTING 
      11]INJ. NORADRENALINE @ 14ML/HR 


                                     DAY 3:

S- C/O DRYNESS OF TONGUE


O- O/E pt AROUSABLE
*BP-100/60 mm of hg on NA @ 20 ml/hr 
*PR-120 bpm
*spo2-93% 
*cvs-s1,s2 +
*RS-BAE + 
*P/A - soft and non tender 
*CNS-B/L pupils NSRL
E4V15M6


A- UROSEPSIS SEPSIS SECONDARY TO POST RENAL OBSTRUCTION 
POST RENAL AKI SECONDARY TO ? B.O.O
B/L MODERATE HYDROURETERONEPHROIS
VESICLE CALCULUS (5MM)
UREMIC ENCEPHALOPATHY 

1]INJ. MEROPENEM 500mg/IV/BD
      2]INJ.PAN 40
      3]INJ. ZOFER
      4]IVF 1NS , 1RL @50 ML/MIN 
      5]INJ. LASIX 20 
      6]TAB PCM 650 
      7]TAB NODOSIS  500
      8]BP,PR,TEMP MONITORING
      9]RT FEEDS [free water milk + protein 100 ml 4th hourly 
      10]STRICT I/O CHARTING 
      11]INJ. NORADRENALINE @ 14ML/HR 


                                         DAY 4  :

O- O/E pt concious 
*BP-80/40 mm of hg on NA @ 20 ml/hr 
*PR-120 bpm
*spo2-93% 
*cvs-s1,s2 +
*RS-BAE + 
*P/A - soft and non tender 
*CNS-B/L pupils NSRL
E4V15M6


A- UROSEPSIS SEPSIS SECONDARY TO POST RENAL OBSTRUCTION 
POST RENAL AKI SECONDARY TO ? B.O.O
B/L MODERATE HYDROURETERONEPHROIS
VESICLE CALCULUS (5MM)
UREMIC ENCEPHALOPATHY 
2 SESSIONS OF DIALYSIS DONE 



P-
      8]BP,PR,TEMP MONITORING
      9]RT FEEDS [free water milk + protein 100 ml 4th hourly 
      10]STRICT I/O CHARTING 
      11]INJ. NORADRENALINE @ 14ML/HR 
      12]INJ DOBUTAMINE @ 10 ML /HR 
  1]INJ. PIPTAZ 45mg/IV/BD
      2]INJ.PAN 40
      3]INJ. ZOFER
      4]INJ OPTINEURON LAMP IN 100 ML / IV / OD 
      5]INJ. LASIX 20 
      6]TAB PCM 650 
      7]TAB NODOSIS  500
                                       DAY 5:

O- O/E pt drowsy but arousable 
*BP-60/40 mm of hg on NA @ 20 ml/hr 
*PR-120 bpm
*spo2-93% 
*cvs-s1,s2 +
*RS-BAE + 
*P/A - soft and non tender 
*CNS-B/L pupils NSRL
E4V15M6


A- UROSEPSIS SEPSIS SECONDARY TO POST RENAL OBSTRUCTION 
POST RENAL AKI SECONDARY TO ? B.O.O
B/L MODERATE HYDROURETERONEPHROIS
VESICLE CALCULUS (5MM)
UREMIC ENCEPHALOPATHY 
2 SESSIONS OF DIALYSIS DONE 



P-  1]INJ. MEROPENEM 500mg/IV/BD
      2]INJ.PAN 40
      3]INJ. ZOFER
      4]IVF 1NS , 1RL @50 ML/MIN 
      5]INJ. LASIX 20 
      6]TAB PCM 650 
      7]TAB NODOSIS  500
      8]BP,PR,TEMP MONITORING
      9]RT FEEDS [free water milk + protein 100 ml 4th hourly 
      10]STRICT I/O CHARTING 
      11]INJ. NORADRENALINE @ 14ML/HR 

                                     DAY 6 :
S- 


O- O/E pt concious 
*BP-80/60 mm of hg on NA @ 20 ml/hr 
*PR-120 bpm
*spo2-93% 
*cvs-s1,s2 +
*RS-BAE + 
*P/A - soft and non tender 
*CNS-B/L pupils NSRL
E4V15M6


A- UROSEPSIS SEPSIS SECONDARY TO POST RENAL OBSTRUCTION 
POST RENAL AKI SECONDARY TO ? B.O.O
B/L MODERATE HYDROURETERONEPHROIS
VESICLE CALCULUS (5MM)
UREMIC ENCEPHALOPATHY 
3 SESSIONS OF DIALYSIS DONE 



P-  1]INJ. MEROPENEM 500mg/IV/BD
      2]INJ.PAN 40
      3]INJ. ZOFER
      4]IVF 1NS , 1RL @50 ML/MIN 
      5]INJ. LASIX 20 
      6]TAB PCM 650 
      7]TAB NODOSIS  500
      8]BP,PR,TEMP MONITORING
      9]RT FEEDS [free water milk + protein 100 ml 4th hourly 
      10]STRICT I/O CHARTING 
      11]INJ. NORADRENALINE @ 14ML/HR 
      12]INJ DOBUTAMINE @ 10 ml/hr 





                                  DAY 7:
S- NO FEVER SPIKES SINCE YESTERDAY


O- O/E pt concious  but irritable 
*BP-110/70 mm of hg on NA @ 20 ml/hr 
*PR-120 bpm
*spo2-93% 
*cvs-s1,s2 +
*RS-BAE + 
*P/A - soft and non tender 
*CNS-B/L pupils NSRL
E4V15M6


A- UROSEPSIS SEPSIS SECONDARY TO POST RENAL OBSTRUCTION 
POST RENAL AKI SECONDARY TO ? B.O.O
B/L MODERATE HYDROURETERONEPHROIS
VESICLE CALCULUS (5MM)
UREMIC ENCEPHALOPATHY 
4 SESSIONS OF DIALYSIS DONE 



P-  1]INJ. MEROPENEM 500mg/IV/BD
      2]INJ.PAN 40
      3]INJ. ZOFER
      4]IVF 1NS , 1RL @50 ML/MIN 
      5]INJ. LASIX 20 
      6]TAB PCM 650 
      7]TAB NODOSIS  500
      8]BP,PR,TEMP MONITORING
      9]RT FEEDS [free water milk + protein 100 ml 4th hourly 
      10]STRICT I/O CHARTING 
      11]INJ. NORADRENALINE @ 14ML/HR 
      12]INJ DOBUTAMINE @ 10 ML /HR 

                                  DAY 8 :
patient's attenders were not willing to have further treatment inspite of explaing the needs of further investigations and they left against medical advice [LAMA]


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