Acute Kidney Injury secondary to Urosepsis

A 60yr old female presented to the OPD with chief complaints of pedal edema since 10 days, decreased urine output since 10 days and fever since 10 days.

History of present illness:

The patient was apparently asymptomatic 5 years back following which she was diagnosed with DM2 on checkup and on Teneligliptin 20 mg. In 2019 ( 2 years ago) she developed fever, shortness of breath and pedal edema and diagnosed with Acute kidney injury secondary to urosepsis and resolved conservatively after dialysis (4 sessions)

Now presented with history of fever, high grade since 10 days, not associated with vomiting and loose stools . Patient complaints pedal edema bilateral and pitting type, with decreased urine output and burning micturition.

History of past illness:

Outside reports suggest acute kidney injury. Known case of diabetes mellitus since 10 years and on tab Teneligliptin 20 mg and not known case of hypertension, bronchial asthma, tuberculosis.

Personal history:

  • Married 
  • Mixed diet
  • Noamal Appetite 
  • Adequate sleep
  • Bowel movement is regular
  • Decreased urine output and burning micturition
  • With no known allergies.
  • Consumes alcohol occasionally.

Family history:

No significant family history

General examination:

  • There is Pallor 
  • There is no Icterus, cyanosis, clubbing
  • Generalized Lymphadenopathy
  • Edema is seen bilaterally witch is Pitting type pedal edema. 
Vitals:
  • Temperature afebrile
  • Pulse rate is 111 beats per minute
  • Respiratory rate is 16 breaths per minute
  • Blood pressure measured on the left hand is 170/110 mm of Hg
  • Oxygen saturation at room air is 90 arm per mm Hg


Systemic examination:

Abdominal system:
  • No scars, sinuses, or any engorged veins.
  • Hernial orifices intact
  • Tenderness or guarding absent
  • No enlargement of liver, kidneys, or spleen
  • No ascites
  • Bowel sounds were normal.
Cardiovascular system:
  • cardiac sounds s1 and s2 heard normally
  • Apex beat located in 5th ICS, medial to the mid-clavicular line.
  • No cardiac murmurs
  • Thrills absent
Respiratory system:
  • No chest wall deformity 
  • Trachea central
  • Expansion is symmetrical
  • Percussion note is resonant
  • Breath sounds normal, no wheeze or crackles heard.
  • Vocal resonance normal and symmetrical
Musculoskeletal system:
  • Gait normal
  • No muscle or soft tissue changes.
  • No bone or joint deformities.
  • No limitation of movements.

Central nervous system:
  • No focal abnormality detected
  • Higher mental functions intact 
  • Cranial nerves I- XII: No cranial nerve abnormality detected.
  • Speech normal

Provisional diagnosis:
  • Acute kidney injury secondary to urosepsis

Investigations ordered:
14/06/21
1. Complete urine examination: 

2. ECG:

3. Ultrasound:



15/06/21:
1. Serum creatinine:


2. Blood sugar Fasting:


3. Blood sugar Random:


4. Blood Urea:


5. Serum Electrolytes:


6. Serum Potassium:



7. Urinary Chloride:

8. Urinary Potassium:

9. Urinary Sodium:



16/06/21
1. Serum Electrolytes:

 

2. Serum Creatinine:


3. Haemogram:


4. Blood urea:


5. ABG:



17/6/21
1. Bacterial culture and Sensitivity Report



18/6/21
1. Serum creatinine:


2. Serum Electrolytes:


3.Haemogram:


4.Blood urea:



21/6/21
1. Complete Blood Picture (CBP)


2. Bacterial culture and Sensitivity Report



Blood urea:

15/6/21 - 65 mg/dl
16/6/21 - 62 mg/dl
18/6/21 - 76 mg/dl
21/6/21 - 81mg/dl

Serum creatinine:

15/6/21 - 3.4 mg/dl
16/6/21 - 3.4 mg/dl
18/6/21 - 3.2 mg/dl
21/6/21 - 3.1 mg/dl

Total leukocytes count:

16/6/21 - 24700
18/6/21 - 26500
21/6/21 - 31700

Serum Electrolytes:

15/6/21 - Na: 139 ; K: 5.2 ; Cl: 106
16/6/21 - Na: 138 ; K: 5.1 ; Cl: 105
18/6/21 - Na: 136 ; K: 4.9 ; Cl: 102
21/6/21 - Na: 134 ; K: 5.5 ; Cl: 98

Diagnosis:

Acute kidney injury secondary to urosepsis with hyperkalemia ( resolved)
With anenmia of chronic disease 

Treatment:

15/06/21:

Treatment:
  • Inj LASIX 40mg (8am- 2pm -8pm)
  • IVF - NS @ UO + 50 ml/hr


15/6/21, 5:30 p.m.

Treatment:
  • Inj LASIX 40mg (8am -2pm -8pm)
  • IVF - NS @ UO + 50 ml/hr


16/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID          1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - XT PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 4 respules    [ 1 - 1 - 1 - 1 ]


17/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID    1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - XT  PO/OD
  •  Tab OROFEA - XT  PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 2 respules
  •  Strict I/O charting


18/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID   1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - XT  PO/OD
  •  Tab OROFEA - XT  PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 2 respules  QID
  •  Strict I/O charting
  • Tab ULTRACET 1/2 tab QID [ 1/2 - 1/2 - 1/2 - 1/2 ]

19/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID    1 -1 - 1
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - 500 mg  PO/OD
  •  Tab OROFEA - XT  PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 2 respules  QID
  •  Strict I/O charting
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]

20/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - 500 mg PO/OD
  •  Tab OROFEA - XT PO/OD
  •  Inj HAI s/c
  •  Neb plain Asthalin 2 respules QID
  •  Strict I/O charting
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
  •  BP/PR/SO2/Temperature monitoring
  •  GRBS charting

21/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  IVF - NS @ UO + 50 ml/hr
  •  Inj MAGNEXFORTE 1.5 gm/IV/BD
  •  Tab NODOSIS - 500 mg PO/OD
  •  Tab OROFEA - XT PO/OD
  •  Inj HAI s/c TID  [ 10U - 8U - 8U ]
  •  Neb plain Asthalin 2 respules QID
  •  Tab Norflox 200 mg PO/BD
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
  •  BP/PR/SO2/Temperature monitoring
  •  GRBS charting
  •  Strict I/O charting

22/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  IVF - NS @ UO + 50 ml/hr
  •  Tab Norflox 200 mg PO/BD
  •  Ing OPTINEURON 1amp in 100 ml  NS IV/OD
  •  Tab OROFEA - XT PO/OD
  •  Tab SHELCAL-CT PO/OD
  •  Inj HAI s/c TID [ 10U - 8U - 8U ]
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
  •  BP/PR/SO2/Temperature monitoring
  •  GRBS charting
  •  Strict I/O charting

23/6/21

Treatment:
  •  Inj LASIX 40 mg IV/TID [ 1 -1 - 1 ]
  •  Tab Norflox 200 mg PO/BD
  •  Tab ULTRACET 1/2 tab QID[ 1/2 - 1/2 - 1/2 - 1/2 ]
  •  Tab OROFEA - XT PO/OD
  •  Tab SHELCAL-CT PO/OD
  •  Inj HAI s/c TID [ 10U - 8U - 8U ]
  •  BP/PR/SO2/Temperature monitoring
  •  GRBS charting
  •  Strict I/O charting

































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