Snake Bite causing Renal damage
NEPHROLOGY ADMISSION
A 65 year old male from Akinepalli , farmer by occupation came with the chief complaints of fever since 1 month( on and off) - subsided now , Right lower limb swelling since 1 month.
Patient was apparently asymptomatic 7 years ago, then he had loin pain and H/O surgery for renal calculi.
Five years ago patient had chest pain and sweating - diagnosed as MI AND PTCA done in Hyderabad. Then , patient used medications for few days about 1 year, and discontinued later, as he was feeling well. He used to go to farm and do his regular activities at home .
Two years ago , patient stopped going to work in view of bilateral knee pain and generalised weakness and stayed at home.
He used to have regular checkups every 6 months and had no H/O comorbidities or no usage of NSAIDs.
One month ago, patient had H/O unknown bite one evening when he was in farm and then started swelling of Right lower limb associated with pain and redness which gradually progressed.
H/O fever ( on and off ) , high grade associated with chills and rigors subsided now . Patient visited kamineni and advised admission, but patient not willing and went home . later his swelling increased and oozing started , blebs appeared on right lower limb , then patient visited nalgonda private hospital and dressings done. He was advised surgery for cellulitis but in view of cardiac issues and reffered to ESI hospital, where they did debridement.
Patient stayed for 5 days there in ESI hospital where they advised HD - but patient not willing and went home ,
Later he developed SOB and decrease in urine output, so went Mallareddy hospital, where they did 4 sessions of HD , Patient left on LAMA from that hospital. He stayed at home for 10 days and continued daily dressings at home,
Patient complaints of loss of appetite , No H/O fever , vomitings
Patient C/O red urine and bleeding from urethra since 3 days ( history of Foley's removal) , epistaxis since 3 days , patient is oriented to time, place and person and C/0 loss of appetite and pain over LL
On examination:
VITALS:
Temp : 98.9 F, PR 90bpm, BP 130/80 mm Hg, SpO2 98% at room air
CVS: S1 S2 heard, no murmurs
RS: BAE+ NVBS +
PER ABDOMEN : Soft , non tender
Provisional diagnosis:
Sepsis secondary to ? Right lower limb cellulitis c ulcers secondary to viper bite.
? AKI on CKD( ? diabetic nephropathy)
hFrEF( Secondary to CAD )
Anemia under evaluation ( secondary to blood loss and CKD)
Deranged coagulation profile
? Denovo DM 2
Investigations:
RFT @ 26/08/21
ABG @ 26/08/21
SERUM IRON
Day1:
1) Oral fluids less than 1.5L/day
2) inj PIPTAZ 2.25 gm/ IV/TID
3) Inj PAN 40mg/ IV/ OD
4) Inj ZOFER 4mg/IV/SOS
5) Inj LASIX 40mg /IV/SOS
6) Tab CHYMORAL FORTE PO/TID
7) T METXL 50mg/PO/OD
8) T ATORVAB 40mg /PO/
9) T NORDOSIS 500mg /PO/OD
10) T SHELCAL PO/OD
11) T OROFER XT PO/BD
2 FFP Transfusions done at 7:00 and 7:30 PM
1 session of Hemodialysis done @10 PM on 26/08/21
Day 2:
1) Oral fluids less than 1.5L/day
2) inj PIPTAZ 2.25 gm/ IV/TID
3) Inj PAN 40mg/ IV/ OD
4) Inj ZOFER 4mg/IV/SOS
5) Inj LASIX 40mg /IV/SOS
6) Tab CHYMORAL FORTE PO/TID
7) T METXL 50mg/PO/OD
8) T ATORVAB 40mg /PO/
9) T NORDOSIS 500mg /PO/OD
10) T SHELCAL PO/OD
11) T OROFER XT PO/BD
Day 3:
Hb 6.6 , TLC 11,100 PC 3.03
Urea: 182 ( increased from 148 )
Creatinine: 3.7 ( increased from 2.9)
Uric acid: 9.2
HD @ 1:00 PM today
1) Oral fluids less than 1.5L/day
2) inj PIPTAZ 2.25 gm/ IV/TID
3) Inj PAN 40mg/ IV/ OD
4) Inj ZOFER 4mg/IV/SOS
5) Inj LASIX 40mg /IV/SOS
6) Tab CHYMORAL FORTE PO/TID
7) T METXL 50mg/PO/OD
8) T ATORVAB 40mg /PO/
9) T NORDOSIS 500mg /PO/OD
10) T SHELCAL PO/OD
11) T OROFER XT PO/BD
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