70/M WITH COVID, DECREASED URINE OUTPUT, PEDAL EDEMA, FACIAL PUFFINESS AND SHORTNESS OF BREATH.

M Bhuvana phanindra, MBBS, 8semister, rollno :74.

This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome .

In order to comprehend and analyse the outcome of the patient the following e-log will be focusing on patient centered covid progression along with the co-morbid condition related to his renal system.

Following is my reflection of case sheet:

Presenting complaints:

70 year old male with 

*Decreased urine output* since,3days.

*Pedal EDEMA* since, 2days*

*shortness of breath* since, 1day* 

*Facial puffiness* since,1day.

Came to hospital on 9/05/2021.

On admission into the hospital , Rapid antigen tested *positive* for COVID .

History of presenting illness

H/o *similar episode* 1 year ago,∆AKI on CKD secondary to Bronchopneumonia.  6sessions of hemodialysis done, was on ventilator extubated later.

H/o *NSAID abuse* for lower back pain.

Past history:

No H/o Dm, HTN, coronary heart disease, epilepsy, TB, Leprosy.

Personal history:

Married, shepherd by occupation.

Appetite-N, Non vegetarian, Bowel-normal. 

Bladder- *decreased output*

No known allergies and addictions.

Family history:

Not significant.

No other family member effected by covid.

General physical examination:

Moderately built and nourished.

Pallor +ve,

icterus -ve,

cyanosis -ve,

clubbing -ve,

lymphadenopathy -ve,

edema -*facial puffiness*+ve,

               *Bipedal edema*+ve.

Respiratory rate: *26 cycles* per minute

Blood pressure:*70/40 mm of Hg*.

Pulse rate: 103 beats per minute.

Spo2: stable at 100% with 5liters of o2.

GRBS: 160mg%.

SYSTEMIC EXAMINATION

CVS

S1 and S2 heart sounds heard.  

No murmurs heard.

Respiratory system

Trachea is central in position.

The patient is dyspneic and wheeze is present.

Tubular breath sounds heard.

Crepts were heard.

CNS

Intact

Abdomen

Soft and non-tender.

Bowel sounds were heard.

Investigations :

Rt-pcr: for covid-19 viral identification, result was positive for sars covid-19.

ABG: 

pH: 7.06  slightly on the lower side.(N7:35-7:45)

pCo2: 102 *highly increased* (N:35-45)

HCo3: 27.6 (N:22-28)

Complete blood picture:

HB: 6.7 (Anemia)(N14-16g%)

TLC: 30,000 *increased*(N4000-10,000)

N:90%*increased* (N40-70%)

L:5%* decreased* (N20-40%)

PLT: 1.63lakhs (1.41-4.1lakhs)

Impression:Normocytic normochromic Anemia with normocytic leucocytosis.

Renal function tests:

Blood urea: 71mg/dl, *increased* (15-40mg/dl)

Serum creatinine: 3.7mg/dl, *increased* (0.6-1.4mg/dl)

Serum uric acid: 3.4 mg/dl *decreased* (4-7mg/dl)

Sodium:140meq/l (135-145meq/l)

Pottasium:4meq/l (3.5-5.5meq/l)

Chlorine: 99meq/l (96-106mew/dl)

ECG:

Provisional Diagnosis: AKD ON CKD , Associated with COVID PNEUMONIA.

Treatment plan:

inj lasix 40 mgiv/bd

tab dinidipine 10 mg/polod

tab nodosis 500mg/po/bd

tab orofer-xt/po/od

tab shelcal/po/od

strict i/o charting

inj pan 40 mg/iv/od

temp charting 4th hourly

tab dolo 650 mg/po/sos

neb budecort 8th hourly

02 inhalation to maintain spo2>90%

inj.dexamethasone 8mg/od.

**Hourly monitoring of Spo2,Bp,pulserate.

09/05/2021; 8am. Patient developed altered sensorium, yet had stable O2 saturation

10/05/2021; 2:30am. Patient developed cardiac pulmonary arrest.

10/05/2021; 2:45am. Patient despite resuscitative measures patient could not be revived and declared dead at 2:32am.

Cause of death: . cardiopulmonary arrest

                               . Respiratory hypotension.

Antecedental cause of death: 

. covid-19pneumonia,

.AKI ON CKD,

.septic encephalopathy.