History taking #1| Acute Kidney Injury | Mr DOCTOR |
•A 28 years old male married patient resident of mardan, Tailor by profession presented to Emergency department with the chief complaints of
- Vomiting (for the last 3 days)
- Diarrhea (for the last 3 days)
- Fever (for the last 3 days)
• Vomiting was yellow in colour , having blood along with sputum ,it was projectile and frequency was about 10 times a day.
• The patient was also having Diarrhea which was watery in consistency, green in colour,and frequency was once in every ten minutes with no associated symptoms .
• Patient also experienced high grade fever of 101°C which was documented ,continuous in character ,with no chill's and aches and was relieved with medication .
• Past medical and past surgical history of patient was non significant.
• His family history was also non significant.
• The patient sleep cycle was normal, Bowel habits was disturbed, he was addicted to Chars since 20 years
• Patient allergy history was also non significant
• Patient travelled to Swat last weak and spend 2 days there but was alright since his return
•He was belonging to a middle class family .His family consist of 11 members and all were using same their water and sanitation system was satisfactory.
• All of his Body system ere intact on systemic inquiry.
Differential Diagnosis : Food poisoning, Gastrointestinal problems (Gastritis, Pancreatitis, hepatitis etc), medication side effects, viral infection, urological problems (Prostatitis, pelvic inflammatory disease etc)
Physical examination:
_ check out for sunken eyes in case of diarrhea
_pinching of skin (pinched skin become normal after some time in case of severe diarrhea)
Investigation:
-Input= output monitoring
-Renal function test (creatinine, urea level)
-Serum electrolytes (K+,Na+)
-GCS checking (Consciousness)
•This patient was having raised RFTs, normal GCS,His eyes were sunken,serum electrolytes were also normal .
1. Reduced urine production
2. Fluid overload
3. Electrolyte imbalance
4. Waste accumulation
Stages:
1. Stage 1: Mild (increase in creatinine 1.5-1.9 times baseline)
2. Stage 2: Moderate (increase in creatinine 2-2.9 times baseline)
3. Stage 3: Severe (increase in creatinine 3 times baseline or need for dialysis)
Causes:
1. Ischemia (hypotension, shock)
2. Nephrotoxins (medications, contrast agents)
3. Obstruction (kidney stones, tumors)
4. Infection (sepsis, pyelonephritis)
5. Surgery
Risk Factors:
1. Pre-existing kidney disease
2. Diabetes
3. Hypertension
4. Heart failure
5. Advanced age
Symptoms:
2. Fluid overload (edema, shortness of breath)
3. Fatigue
4. Confusion
5. Nausea and vomiting
Diagnosis:
1. Serum creatinine
2. Urine output
3. Electrolyte panel
4. Imaging studies (ultrasound, CT scan)
5. Urinalysis
Treatment:
1. Fluid management.
2. Electrolyte correction
3. Medication adjustment
4. Dialysis (if necessary)
5. Addressing underlying cause
Complications:
1. Chronic kidney disease
2. End-stage renal disease
3. Cardiovascular disease
4. Increased mortality
Prevention:
1. Volume optimization
2. Avoiding nephrotoxins
3. Monitoring kidney function.
4. Early recognition and intervention
Guidelines:
1. KDIGO (Kidney Disease: Improving Global Outcomes).
2. AKI guidelines (American Kidney Foundation)
3. European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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