Concluded Case

CKD with CAD with bilateral pleural effusion

65 years old male - Non - diabetic , hypertension- controlled on Amlodipine 5 mg , a known case of CKD on regular treatment, CAD with CABG done 5 years back , c/ o DOE . He was investigated and investigations were alarming. HB- 7.5 BUN - 84 S.creatinine - 6.93 mg % X- ray chest significant bilateral pleural effusion and cardiomegaly. Due to Lockdown- Patient could not got regular consultation. Before Lockdown his creatinine was 3.5 and was on Dytor 20 mg B.D , Ecosprin AV 75 / 20 , Amlodipine 5 mg , Carca 3.25 B.D , Alpha ketoanalogue , iron and calcium supplements. Opinion in this case from experts welcomed

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Concluded answer
Bilateral pleural effusion with creatinine of 6.9 mg/dl It clearly suggest that this patient is in fluid overload Plan Restrict/ Stop all fluid intake Use diuretic to remove fluid from intravascular compartment - preferably quick acting diuretic such as furosemide Insert Central venous catheter and monitor Central venous pressure Bedside ultrasonography - to look for fullness of inferior Vena Cava and collapsibility of IVC during breathing, which suggest fluid status Check for B lines on sonography of lungs, more the number of B lines , more severe is fluid overload, it can be used to see real time status of fluid overload Send electrolyte level and arterial blood gas, to check for hyperkalemia and acidosis and treat it. Keep provision of emergency dialysis, in case remedial measures fail.
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Bilateral pleural effusion with creatinine of 6.9 mg/dl It clearly suggest that this patient is in fluid overload Plan Restrict/ Stop all fluid intake Use diuretic to remove fluid from intravascular compartment - preferably quick acting diuretic such as furosemide Insert Central venous catheter and monitor Central venous pressure Bedside ultrasonography - to look for fullness of inferior Vena Cava and collapsibility of IVC during breathing, which suggest fluid status Check for B lines on sonography of lungs, more the number of B lines , more severe is fluid overload, it can be used to see real time status of fluid overload Send electrolyte level and arterial blood gas, to check for hyperkalemia and acidosis and treat it. Keep provision of emergency dialysis, in case remedial measures fail.
Valuable opinion
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FURTHER PLAN 1 INTAKE OUTPUT CHART 2 FLUID INTAKE 600 CC / 24 HRS 3 SALT 3 GM / DAY 3 PROTEIN IST CLASS PROTEIN 40 GM / DAY 4 DAILY BODY WEIGHT 5 NO ARB / ACE I 6 IF DYSPNOEA ++ THERAPUTIC ASPIRATION PL FLUID MAY BE DONE 7 BLOOD K + Ca ++ po3/4 .pTH = 2ndary hyperparathyroidism ERYTHROPOITEN 9 24 hrs urine na + protein 8 ORAL IRON + ERYTHROPOITEN S/ C 4000 units s/c once - twice wk ly
The patient has massive pleura effusion due to CHF Need IV high dose furosemide. 80 mg start. eGFR anemia ussualy most common when eGFR less than 25. Combine amlodipine with ARB LIKE candensartan will be better. ECG for structural heart disease.
I agree
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Post CABG status Xray chest bilateral pleural effusion and cardiomegaly Calcified aortic knuckle Kco ckd presenting with high sr creatinine and blood urea and pt is diabetic Infact pt needs dialysis Iv lasix Increase diuresis and restrict input
Thank you doctor
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