50 YR OLD FEMALE WITH ACUTE GASTRITIS

 

A 50 year old female came to the casuality on 28/09/21 with chief complaints of :

1. Pain abdomen since 2 hours 

2. Vomiting since 2 hours

3. Loose stools since 2 hours 

HOPI:

Patient was apparently asymptomatic 2 hours back when she developed pain abdomen, more in the right iliac fossa, which was sudden in onset and gradually progressive, a/w vomiting( 2 episodes), non bilious, non projectile.

Complaint of loose stools, 3 episodes in a day, non foul smelling, non blood tinged.

PAST H/O:

A k/c/o diabetes Mellitus and hypertension since 10 years.

Patient was previously admitted in General Medicine Department  on 7/9/21

Link to previous Elog: http://selinakm89.blogspot.com/2021/09/50f-aki-on-ckd-diabetic-foot-kco-dm.html

Last dialysis 15 days back 

VITALS:

Temp- 98.5 F

BP- 140/80 mmhg

PR- 99

RR- 18 cpm

GRBS- 323 mg/dl

SpO2- 99% at room air 

O/E:

CVS- S1 S2 + No murmurs 

RS- BAE + NVBS

CNS- NAD

P/A- Soft, Tenderness present in epigastric region 

PROVISIONAL DIAGNOSIS:

Acute Gastroenteritis 

INVESTIGATIONS:

USG Impression:

Rt moderate hydronephrosis

Raised echogenicity of both kidneys.

Internal echoes in urinary bladder.

Lt simple renal cortical cyst.

DIAGNOSIS:

Pre Renal AKI on ? CKD ( secondary to Acute GE) with k/c/o DM since 10 years

K/c/o HTN since 10 years with Rt Diabetic foot.

Treatment:

DAY 1:

1. Intravenous fluids- RL, NS at 50ml/hr

2. Inj. METROGYL 500mg/IV /TID

3. Inj TRAMADOL 1 ampule in 100ml    NS/IV/SOS

4. Inj HAI Pre meal s/c  TID

     8AM-2 PM-8PM

5. Tab PAN 40mg PO/OD

6. Tab ZOFER 4mg PO/SOS

7. Inj. Vancomycin 1g in 100 ml NS / IV/ slowly through central line over 1 hr 

8. ORS Sachet in 1 litre of water to drink throughout the day after each stool.

9. GRBS Monitoring 6th hourly

DAY 2:

IVF - RL, NS @ 50 ml/hr

Inj. Metrogyl 500 mg IV/TID

Inj. Tramadol 1 amp in 100 ml NS / IV/ SOS

Inj HAI Pre meal/ SC/ TID

Tab. Odenseteron 4 mg / PO/ SOS

Tab. PAN 40 mg PO/ OD

Tab Zofer 4 mg / SOS

Daily dressing for diabetic foot 

ORS Sachet after each episode of loose stool.

GRBS charting 8th hourly 

Day 3:

1. Intravenous fluids- RL, NS at 50ml/hr

2. Inj. METROGYL 500mg/IV /TID

3. Inj TRAMADOL 1 ampule in 100ml NS/IV/SOS

4. Inj HAI Pre meal s/c  TID

     8AM-1PM-8PM

5. Tab PAN 40mg PO/OD

6. Tab ZOFER 4mg PO/SOS

7. Dressing for Diabetic foot done 

8. GRBS Monitoring 8th hourly

Day 4: 

1. Intravenous fluids- RL, NS at 50ml/hr

2. Inj. METROGYL 500mg/IV /TID

3. Inj TRAMADOL 1 ampule in 100ml NS/IV/SOS

4. Inj HAI Pre meal s/c  TID

     8AM-1PM-8PM

5. Tab PAN 40mg PO/OD

6. Tab ZOFER 4mg PO/SOS

7. Dressing for Diabetic foot done 

8. GRBS Monitoring 8th hourly

Patient shifted from AMC to Ward 

Day 5

S : Patient complaining of back pain since morning, 1 episode of loose stools in the morning

O :

Pt c/c/c

Temperature : 98.2 F

BP : 130/80mm Hg

PR : 97bpm , regular

GRBS : 208mg/dl at 8AM

CVS : S1 S2 +, no murmur

RS : NVBS + , no crepts

P/A : soft, non tender

Hb- 7.4

TLC - 13,100

PLC-. 2,70,000

PCV- 22.1

RBC - 2.7

A :

Pre renal AKI ? CKD

Secondary to Acute Gastroenteritis with k/c/o DM, 

K/c/o Hypertension since 10 years with right Diabetic foot.

P : 

1. Intravenous fluids- RL, NS at 50ml/hr

2. Inj. METROGYL 500mg/IV /TID

3. Inj TRAMADOL 1 ampule in 100ml NS/IV/SOS

4. Inj HAI Pre meal s/c  TID

     8AM-1PM-8PM

5. Tab PAN 40mg PO/OD

6. Tab ZOFER 4mg PO/SOS

7. Dressing for Diabetic foot done 

8. GRBS Monitoring 8th hourly