Diabetic pt. taking regular insulin OD,also h/o HTN, swelling both upper limbs.both lower limbs, and face.urea 60,creatinine 3.pls. suggest

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Dr Satish,God evening, This is a very clear cut case of Diabetic Kidney Disease leading on to CKD,CRF. The basic pitfall is the pt is on once a day regular insulin which is not the recommended schedule of insulin, may be because of uncontrolled DM & HTN, he developed DKD,CKD,CRF. Order FPG,2hr PG,HbA1c, rpt RFT, USG to r/ o RPD, renal paranchymal disease, ECG,2D Echo to r/ oCCF, Serum Electrolytes. Please avoid Frusemide, as it further leads to electrolyte imbalance.,take the opinion of Cardiologist & Neontologist, Coming to the treatment part meticulously control DM with rapid acting insulin analogues three times a day, try to avoid long acting insulin analogues, unless otherwise the DMis not controlled, Hypertension should be treated with Olmesartan 40 mg once daily,Cilnedipine 10 mg once daily, Tab Torsemide 100 mg once a day, monitor serum Electrolytes, CPG,BP,RFT on regular basis, continue add on therapies like vit D3, Calcitriol,Calcium based on the readings, treat Anaemia by transfusing packed cells, no need to worry as long as there is required urine output, still take a cross consultation od Cardiologist, Neurologist, finally refer the pt to Ophthalmologist to r/o Retinopathy. Keep me posted, stay connected

Disclose the dose & brand of insulin. Though it is a case of Nephropathy landing on CRF but still urine output will say whether acute on chronic. In such case there is recirculation of insulin for which blood sugar remains low even with small dose of insulin. Better to switch to analogue FIAsp for lesser chances of hypoglycemia. Diuretics like Torsemide can be given but monitoring of electrolytes is essential. Also TFT & Sr Calcium, Sr Phosphorus, Sr Magnesium should be done. Funduscopy should be done to assess the level of Retinopathy as it is associated with Nephropathy.

Dr Ravindra tell me one diuretic that does not cause dyselectrolytemia, I said when compared to frusemide the incidence is less with torsemide, that is the reason I repeatedly said monitor Electrolytes. Even 12.5 mg of Hydrochlorothiazide aldo caused hypokalemia in one of my patients.

Most probably patient is landing up in diabetic nephropathy kindly do USG and 24 hour urinary albumin levels and urine R/M

case of diabetic nephropathy - consult a nephrologist

how long diabetic, does pt have diabetic retinopathy

Diabetic Nephropathy. Regular RFTs.Keep watch on the creatinine report. Keep or ready for RRT. Plan for AV fistula. Renal diet. Decrease high potassium and high sodium content diet. Decrease salt and water intake. Daily weight measurement and intake output balance of liquid intake. Start ARB with close watch on serum potassium level.start frusemide high dose as per creatinine level instead of spironolactone.Check for acidosis.

DM NEPHROPATHY CKD HTN RX HTN IF ON ACE / ARB = STOP THOSE RX CILNIDIPINE CTD CLONIDINE BETABLOCKER MAY BE CHOSEN SALT RESTN. 3 g / day FLUID = 1 L / DAY PROTEIN RESTN. 30 g / DAY DIURETICS FRUSEMIDE/TORASEMIDE CALCIUM SUPPLEMENT NODOSIS 500 mg BD GLYCEMIC CONTROL HYPERTENSION CONTROL BLOOD K + Ca ++ PO 3/4 PARATHORMONE eGFR

a case of acute on chronic diabetic kidney failure with fluids over load. give lasix 60 mg tds. monitoring uop and do electrolyte, calcium, lft, cbc, usg abdomen, pelvis and also ecg echo for r/ o cardiac failure. omite the telmikind tab and give plain amlodipine

It is due to Congestive cardiac failure And tablet Lasix once a day for two days wil help but under observation and due to lasix creatine levels might go up a little but will come down after the symptoms subsides

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