55 year old man with ? Viral pneumonia in uremic encephalopathy and acute Pyelonephritis secondary to UTI with AKI and ? Viral Myocarditis

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55 year old man, working as a Maestri at Sukanapally presented to casualty at 8pm with the complains of

Reduced urine output since 12days

High colored urine since 12 days

Pain abdomen radiating to back since 12 days

Dyspnea at rest since 8 days

Cough with expectoration since 7 days 

Fever since 7 days

Drowsy and irritable since morning 

He works as a Maestri at Sukanapally near chityal. He got married to a farmer and has 4 children, 3 sons and a daughter. He haa been regularly consuming alcohol daily since the like 7- 8 years , he has been consuming around 90 ml of whiskey. He was an occasional alcoholic since 25 years prior. He has been smoking around 10 beedis per day since the last 20 years. 

He was diagnosed to be a hypertensive and diabetic 5 years back on visiting a local hospital for giddiness.

2 years back he was diagnosed with cva and the patient has been on Ecosprin AV and clopidogrel ever since. The attendants are unable to recall the side of weakness , though they tell us that the weakness gradually improved over a span of 10 days. 

Since 12 days he has been experiencing reduced urine output along with high colored urine. He also has been apparently experiencing pain in his right lumbar region radiating to loin since 12 days.

Also has been complaining of abdominal distension since 9 days and has been experiencing breathlessness since 9 days on exertion which isn't associated with pedal edema, chest pain, palpitations, sweating, nausea. His dyspnea was apparently sudden in onset and gradually progressive to a state that he started to feel breathless even at rest. He also has been complaining of productive cough since 6 days with scanty , mucoid and non blood tinged sputum. He also tells that he has been having fever with chills on and off which relieved on medications. He has been drowsy and irritable since morning. 

He was taken to a local hospital, Healthcare hospital where in he got diagnosed with Pyelonephritis, septic shock, AKI and ARDS. He was put on deriphyllin, Meropenem, Norad & Dopamine. 

His outside reports show a serial raise in TLC along with fall in platelet counts

Latest report from 21/8 - shows a tlc of 31,200 with a platelet count of 50,000. Sr creatinine of 4 mg/dl. Also urine reports of  Pus cells 10- 12 

Albuminuria 3 plus

RBCS 3 Plus 

At presentation 

His RR was 35 cpm 

Sats maintaining at 97 %

Grbs - 387

Bilateral pedal edema +

PR - 170 bpm

BP - 80 systolic BP

Temp - 99 F

Cvs - S1,S2

Lungs - reduced breath sounds in left IAA

His outside reports 

18/8

TLC - 16,600

Plt - 53,000

Sr. Creatinine- 4.3

Bl urea - 83

Cue showed 3 + albuminuria with 3+ rbcs

Hypoalbuminaemia - 2g/dl

19/8

PLT - 47,000

TLC - 11,000

Sr creatinine - 3.8

Cue - 10 to 12 pus cells

2-4 rbcs

20/8

Tlc - 25,000

Plt - 66,000

Sr creatinine- 3.1

21/8 

Tlc - 31,200

Plt - 50k

Sr creatinine- 4

HRCT on 18

HRCT on 21

CT chest plain - CORADS 6

CT abdomen - from 19/8/20

Acute pyelonephritis 

Minimal ascites 

Right pleural effusion with basal consolidation

Day 1:  

Patient was given amiodorone 150 mg stat , 1 stat injection piptaz 4.5gm iv and continuous fluids

           

RFT

Creatinine:4.6

Blood urea:278

Sodium:153

Pottasium:3.7

Chlorine:110

UA:12.9

 

Day 2:

His heart rate and rythm have reverted

55 year old man with 

Reduced urine output since 12 days 

High colored urine since 12 days

Pain abdomen since 12 days

Dyspnea at rest since 8 days

Cough since 7 days

Fever since 7 days

Drowsy and irritable since morning 

His Problems : 

? Viral Pneumonia

Uremic encephalopathy 

?UTI leading to Pyelonephritis leading to sepsis , AKI

? Viral myocarditis 

Hypoalbuminaemia 

K/C/O type 2 DM and HTN sincd 5 years

H/O CVA 2 years back