47 female f/u/c of chronic kidney disease, on MHD last done 3 days back , admitted with sudden onset breathlessness 2 days . PR - 148/ min Spo2 - 65 % on Room air BP 220/120 mm hg RR - 42/ min Afebrile Output @ 10 ml/ hour USG chest - B lines + Xray chest attached

5 Likes

LikeAnswersShare

Left ventricular failure leading to bilateral pulmonary edema.. Systemic hypertension may be contibutory... Needs oxygen.. CPAP.. Immediate dialysis to remove fluid from the lungs and body.. Intravenous Diuretics if works.. Reduction of blood pressure...

patient is in pulmonary oedema because of CKD. as suggested by CXR & history.treatment is urgent HD. if facilities not available immediately can give lasix & sodabicarb(for metabolic acidosis) .but its only temporary. again there r limitations in giving soda bicarb because of fluid overload .put her on NIV. if altered sensorium or drowsy , then intubate & start invasive ventilation with PEEP. BP on higher side, its due to CKD. first go for HD, then if BP still high treat with arkamine & calcium channel blockers . once patient is out of pulmonary oedema, beta blocker can also be added.

ACE inhibitors & Angiotensin receptor blockers should not be given in renal failure as it can cause worsening of renal function along with risk of severe hyperkalaemia.
0

View 6 other replies

c/o Ckd on Maintenance HD with Uncontrolled Hypertension Cxr s/o Cardiomegaly with Pulmonary edema Cause for Flash pulmonary edema is Ckd patients is due to Uncontrolled HYPERTENSION... So to prevent this, target bp should be less than 130/80 Fluid restriction up to 1 litre/day salt restriction less than 5mg nacl/day Drug compliance and HD should be adviced at least 2 cycles/Week. This pt as to be taken for urgent Haemodialysis with high Ultra filtrate and Ventilatory support based on ABG and Alertness of the patient Beta blockers should be used cautiously in these patients bcoz of BRASH Syndrome, so ecg to be monitored at every visit Acei/ARB'S should be given with proper monitoring of creatinine and K levels every 15 days DASH diet to be followed and avoiding K rich diet Tachycardia due to Ac LVF Frequent Flash pulmonary edema is directly related to CV mortality in CKD pt's...so measures to be taken to prevent it....

Anaemia correction...Target hb% above 10 g%...
0

Pulmonary edema with Pulmonary Hypertension with malignant Hypertension Admission in nephrology department HD ,Lasix slow ,Lasix BD . Oxygen support Olmisartin H 40 Ecosprin OD .

CKD = ON HD RENAL HTN = RESISTANT = DUE TO CKD NOW ON PULM EDEMA CXR CARDIOMEGALY+ PULM . EDEMA SEVERE OLIGURIA HD = AS EARLY AS POSSIBLY O2 INHALATION 6 L / MT BIPAP ---> MECHINACAL VENTILATION SOS AFTER HD IF BP STILL HIGH CHLORTHALIDONE 25 MG OD. CILNIDIPINE 20 MG BD ALPHA BLOCKER 5 MG BED TIME BETA BLOCKER LASIX IV 80 MG BD DEPENDING CLINICAL CONDITION RENAL TRANSPLANTATION WHEN DONAR KIDNEY AVAILABLE

clearly volume overload at interdialytic period ,so first to do urgent HD with UF.IV diuretic will not be helpful if urine output is not adequate as the case,but should be used as temporary measure.lowering BP by NTG can prevent patient from intubation.Bipap can be given.Urgent trop I should be done in casualty.repeat x ray and Echo should be done after stabilisation to ro lv dysfunction and pulmonary hypertension most common in these patients.

pulmonary the edema with hypertension injection lasix last is dialysis

patient has vol overload with HTN failure metabolic acidosis. Back rest. ABG Ecg Diurrtics .Nitroglycerin infusion.Sodabicarb according ABG Bipep/invasive ventilater sos Haemodialysis

perhaps MHD was inadequate...pt. went into volume overload f/b pulm. edema and ABG and CXR is S/O ARDS... iv furosemide 40 mg 8 hrly iv NTG 40-50 microdrps/min rule out metabolic acidosis S. electrolytes ECG

It's interstial pulmonary oedema due to ckd and hypertension.

Load more answers