known case of CKD came with complaints of distended abdomen and difficulty in breathing with fever, patients spo2 is 95 with o2 ,80-85 at room air..

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it looks CKD with liver parenchymal disease with ascites with SBP bilirubin is markedly raised. SEPSIS present. START HIM IN ANTIBIOTICS, DIURETICS. Needs USG ABDOMEN TO RULE OUT CAUSE OF JAUNDICE. (obstructive/liver parenchymal disease)

Hepatorenal syndrome with sepsis Severe deranged Liver function , with obstructive jaundice, and renal failure . Hyponatremia . ECG ,? evolving IWMI , low voltage complexes . Pericardial effusion due to fluid overload . Suggest Abdominal ultrasound, CT abdomen / MRCP to rule out obstruction in biliary pathway. ICU management

Very poor quality of image can't find interval but after too much eye strain see only few things T wave inversion in inf leads & v1 to v3 difficult to rule out IWMI because image is worst D / D. P.E

Sob may be d/t fluid overload.kindly mention stage of CKD,whether on mhd? Treatment will depend on all these,upload cxr pa view

do cxr axr ,O2 with face mask ,what about output ,what about BP pt may be in fluid overload , HRS, in HRS any form of dialysis is bad prognosis ,tap ascitic fluid send for total count proteins , do 1st cxr and axr atach them

ECG shows PR segment higher than ST segment, T Wave inversion in v1-4 suggestive of pericarditis

diagnostic plus therapeutic ascitic tapping

Anterior and inferior wall ischaemia.

ECG shows inferior wall MI. Creatinine 2. 1 relative contraindication for CAG. Can be managed conservatively.

Diuretics adviced to control s creatinine increase the digoxin

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