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@ Chief Complaints Fever for 10 days Nausia with vomiting for 5 days Low urine output with swelling on face and feet for 3-4 days Loss of vision for 3 days with altered sensorium Vitals Bp 220/110 hr 130/min spo2 94% wt 30kg Physical Examination Cns - dull Cvs Tachycardia Diagnosis Gallstone disease Renal failure Malignant htn Nephritis Investigations Hb 12 Urea 250 Creat 8.0 Na 146 k- 3.6 Us abd b/ renal paranchymal disease /gallstones/?fluid overlod Management Antihypertensive Ppi Iv antibiotics inj augmentin Inj lasix infusion Inj dexa Urine output increase 150 ml in 24 hours Vision improved History No relevant history

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Pt requires hospitalization and immediate dialysis. Consult Nephrologist.

Thank you doctor
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Dialysis urgent with admission BP monitoring and electrolyte balance Bolus Doses of antibiotics IV Lasix Maintain out put chart

Rt kidney length 8.8 cm Lt kidney length 8.2 cm Is dialysis is urgent ??
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Ref to Nephrology.

I agree
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Single dialysis can be done. Onc the creat is below 7, plan for native kidney biopsy for LM, IF. For management, 1.) taper the fluid intake to min of 1L per day 2.) Electrolyte balance should be maintained. 3.) BP and urine I/O monitoring 4.) Creat, Na, K daily. 5.) RBS charting 6.) For BP, Arkamin 0.1mg 2 TDS can be give (maintain BP >140/80) 7.) Rule out sepsis. Put on multiple antibiotics. Could add Inj Mero + Targocid. And send Urine R/M, C/S and Blood C/S. 8.) Ask about recent COVID history.

Thank you doctor
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Also send fungal KOH smear to rule of mucor.. since the patient developed loss of vision 3 days back. And MRI brain. Neuro reference/ Gastro surgery reference should be made.

Thank you doctor
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