Concluded Case

COVID-19 Pneumonia in CKD patient

COVID-19 IN CKD , HYPERTENSION, URAEMIC PATIENT. Chief Complaints COUGH , SOB , FEVER , VOMITINGS - 20 days back History A known case of Analgesic and hypertensive nephropathy with CKD on regular dialysis presented with above complaints Vitals Temperature 100 °F Pulse 100 / minute B.P - 140 / 90 mm of Hg R.R - 30 / minute Physical Examination Chest - B/ L coarse crepitatipns and wheeze CVS - NAD Abdomen - NAD Investigations Hb - 8 gm % S.bilirubin - 2.3 mg % S.Urea 105 mg % S.creatinine 8 mg % X- ray chest typical of COVID-19 with CCF HRCT - Atypical viral pneumonia RT - PCR- positive for COVID-19 disease 20 days back - but now RT - PCR is negative Diagnosis Analgesic and hypertensive Nephropathy, CKD and COVID-19 Pneumonia. Management Dialysis has been done Treated as per COVID-19 protocol on Parenteral antibiotics, High flow nasal oxygenation, steroids , anticoagulants Further management welcomed

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Critically ill status Covid19 pneumonitis extensively b/l more in rt side whole lobes are affected Cardiomegaly with PAH seen pulmonary oedema noted As pt is kco hypertensive and NSAIDs ind7ced CKD At present raised bul and sr creatinine with bilirubininia suggest pt is in multiorgan failure Raised portal pressure with RHF and hepatorenal failure Pt was covid positive and now turned negative does not suggest decrease in viral load likely he may face second attack of cytokine storm hence sp02 sustainable is more important Pt has been put on steroids likely on loading doses so he need to be on high doses of diuretics or increase frequency of dialysis Pt is in uricimia not a good sign increase doses of fabuoxate What ecg and 2decho are suggesting as i am feeling pt has myocarditis or ischimia to modify the treatment Does pt recieved inj Remdesivir and how many shots in my opinion he may be given 11 shots So also he may be put on biologics inj Tocizumap at least one shot 240mgin 120ml Besides broadspectrum antibiotics like meropanum 9r piperacillin+inj tazobactum Oral anti lung fibrotics like pirfenidone 400mg tds Ninterna 150mg 1bd Tab pulmoclear 1bd Anticoagulants inj enoxiparum to be continued if on oral dabatigran may be considered Avoid aspirin He needs to be kept on 02 support I will consider ivermectin 18mg+albendazole 1od for 3days and to keep on weekly doses Consider to continue if given or not given tab zinc50mg+tab vit d4000units od for next one month Of course hyperbilirubinimia to be adressed by considering viral load Oral steroids and hepatocellular regeneratives may be given Beside active monitoring Pt should in ICU only

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Critically ill status Covid19 pneumonitis extensively b/l more in rt side whole lobes are affected Cardiomegaly with PAH seen pulmonary oedema noted As pt is kco hypertensive and NSAIDs ind7ced CKD At present raised bul and sr creatinine with bilirubininia suggest pt is in multiorgan failure Raised portal pressure with RHF and hepatorenal failure Pt was covid positive and now turned negative does not suggest decrease in viral load likely he may face second attack of cytokine storm hence sp02 sustainable is more important Pt has been put on steroids likely on loading doses so he need to be on high doses of diuretics or increase frequency of dialysis Pt is in uricimia not a good sign increase doses of fabuoxate What ecg and 2decho are suggesting as i am feeling pt has myocarditis or ischimia to modify the treatment Does pt recieved inj Remdesivir and how many shots in my opinion he may be given 11 shots So also he may be put on biologics inj Tocizumap at least one shot 240mgin 120ml Besides broadspectrum antibiotics like meropanum 9r piperacillin+inj tazobactum Oral anti lung fibrotics like pirfenidone 400mg tds Ninterna 150mg 1bd Tab pulmoclear 1bd Anticoagulants inj enoxiparum to be continued if on oral dabatigran may be considered Avoid aspirin He needs to be kept on 02 support I will consider ivermectin 18mg+albendazole 1od for 3days and to keep on weekly doses Consider to continue if given or not given tab zinc50mg+tab vit d4000units od for next one month Of course hyperbilirubinimia to be adressed by considering viral load Oral steroids and hepatocellular regeneratives may be given Beside active monitoring Pt should in ICU only

@dr Praveen Yograj
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COVID with CKD Reassurance and counciling required. Follow protocols of COVID must be followed and dialysis may be useful if PB maintained properly. Pt already in ICU and we are doing our best but despite all in this case prognosis is very poor therefore proverb is right " I treat ,he cures " Some fight till the end but sometimes feel helpless and clue less.

Thanks Dr Rajinder Rai
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Known pt of covid with ckd Dose of remedesivir reduce by 50 percent Dialysis on alternate day if bp maintain

basically patient is in SEPSIS check for urine output and plan for hemodialysis start on NIV and increase PEEP repeat xray after 24-48hrs

महालक्ष्मी विलास रस स्वर्ण युक्त 1 रत्ती जय मंगल रस स्वर्ण युक्त 1 रत्ती ताली शादी चूर्ण 2 ग्राम शहद में मिलाकर सुबह-शाम सेवन कराएं। इस के उपयोग से श्वशनिक ज्वर में लाभ होगा। उसके बाद अन्य उपद्रव की चिकित्सा आयुर्वेद में शुरू करेंगे।

Pt is Febrile .leucocyte count? .sepsis? Procal,d dimer ,IL6

Serum electrolyte Rest as per icmr direction

@ dr Mehnaz Naqvi

? SEPSIS

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