Bloated, inflamed stomach, swelled legs on LATANOPROST, SERETIDE.

Resolved Question:

The patient is a 76 year old female. Her medical conditions are hypertension, asthma, glaucoma. She was on Losartan 100mg, Amlodipine 5mg, Clopidegral 75. Atovastatin 10mg, Thyroxine 100mcg, Ventolin, Seretide and Xalatan (Latanoprost) and Alphergan P.

Two weeks back she fell and broke her ankle and was hospitalised. She complained of abdominal pain and a contrast CT scan was done. Before the contrast was administered her creatinine level was check and it was 0.84mg/dL

The day after the administration of the contrast her creatinine level was 1.4 mg/dL.

Within 72 hours her creatinine level increased to 6.5 mg/dL Her pottasium level increased so did blood urea and her sodium level dropped. Dialysis was done but no improvement in her condition is seen. Urine output is low. She is not evacuating stool and her stomach is very bloated and inflamed. Her legs are swelled. She consumes very little food.

Attached is the ultrasound scan and some of the blood test results. Would appreciate if you could let me know your opinion and suggestions to recover her kidney function if possible. Thank you


Category: Nephrologist

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Category: Pediatric Nephrologist
Dr. Sree Bhushan Raju is online now

Expert:  Dr. Sree Bhushan Raju replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
This what is classically described as contrast induced nephropathy. She is vulnerable to develop such an insult and injury due to her age, hypertension status and being on losartan. The best way was prevention and enough care must have been taken to prevent such an injury and despite such measures ,she would have developed CIN. Though, not possible practically in all cases, she would improve her kidney function with CRRT rather than conventional hemodialysis. You need to wait for few more days for recovery. Maintain good nutrition, adequate hydration , see that she receives appropriate antibiotic if she has urine infection ( should be checked for ) and thyroid is with in normal limits with therapy. Keep her general condition well and not to restrict her to bed or wheel chair . Give her physiotherapy and a positive environment around.. Keep in touch
Feel free to discuss further.


Patient replied :

Dear Doctor
Thank you very much for your valuable opinion. My follow up question is as follows:
Dialysis was done last night and her blood was tested this morning the results are as follows.
Sodium 125 mmol/L
Potassium 5.2 mmol/L
Blood Urea 107.0 mg/dL
Blood Urea Nitrogen 49.2 mg/dL
Creatinine 6.1 mg/dL
Uric Acid 5.4 mg/dl

Another dialysis session is planed for tomorrow night. In your opinion is the result accepted of a 4 hour session.
What will be the best food and liquid we can give her?

thank you


Expert:  Dr. Sree Bhushan Raju replied 3 Days.

Hi
We can't rely on the blood reports now at this time to assess the kidney function. Let her be on dialysis and watch the urine output. Let her drink 1.5 of water (all liquids) per day and see.
Let her eat all vegetarian diet of her choice and which is her routine diet.
Keeps track of her biochemistry
Best



Patient replied :

Hi again. After some days on dialysis the patient blood results had shown improvement without doing a dialysis. On the day after the dialysis her creatinine level was 3.7 mg/dL , Sodium 129 mmol/L and potassium 4.7 mmol/L , blood urea 108 mg/dL and BUN 49.7 mg/dL. Without a further dialysis her blood results improved. Creatinine is now 2.1 , pottasim 4.4, Sodium 131, Urea 94.9 and BUN 43.2 However, it had been discovered her urine had been infected with klebsiella species and is only sensitive to Amikacin.
Second day without dialysis creatinine level has come down to 1.1 but the sodium level remains at 131.
Initially her WBC was over 22.5 but now it has come down to 11.5 she is on Meropenem . Senstitvity test was not done for this antibiotic.
The patient is allergic to penecilin and sulfur based medicine. What will be the best course of action please. Thank you


Expert:  Dr. Sree Bhushan Raju replied 2 Days.

Hi
As stated, it is reversible and you need to wait with patience. She will be given drugs to maintain the kidney function at the same level. Improve her diet, cheer her up and maintain at least 2 -2.5 lit of fluids daily. She won't require dialysis any further but we need to see how low she can come down in her creatinine. Keep updating till she totally improves her creatinine.
Best


Dr. Sree Bhushan Raju
Category: Pediatric Nephrologist
Experience: 
FISN : Fellowship of Indian Society of Nephrology(ISN), 2012
FIACM : Fellowship of Indian Association of Clinical Medicin(IACM), 2012
FICP: Indian College of Physicians Association of Physicians of India, 2012
Fellowship: DM, DNB, All India Institute of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, Nizam's Institute of Medical Sciences, 1998
Medical School: MBBS, Gandhi Medical College, 1994
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