Concluded Case

SEVERE ANAEMIA IN AN 82 YRS OLD FEMALE

82/Female admitted with Severe Anaemia(Hb-6.5) for blood transfusion.Known Hypertensive and diabetic.Patient getting SOB since 3 days. H/o - Multiple episodes of loose stools 3daya back treated by patient attendants themself only,S.creat -5.8,K DIAGNOSIS AND MANAGEMENT PLAN?

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Diabetic and hypertensive pt presenting with sob Xray chest shows homogeneous opacity rt lower zone suggestive of pleural effusion Pt is severely anaemic having sr creatinine 5.8mg suggest CKD Adv tapping for diagnostic and therapeutic treatment Pt needs to evaluate the renal disease eGFR to be calculated Aged pt control diabetes and hypertension Diuretics and specific treatment for pleural effusion after analysis report Also adv for covid testing

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Right sided pleural effusion with raised creatinine and low Hb Multiple directions of investigation 1) Why creatinine if raised? Is there any obstructive uropathy? - ultrasonography will help rule out obstructive uropathy Is the renal failure prerenal type or renal type? BUN : creatinine ratio of more than 10 : 1 will suggest prerenal type of renal failure 2) What is the cause of low Hb? Is it due to blood loss or due to renal failure? Iron profile will help in resolution of this issue. Low iron and low ferritin will indicate blood loss and high iron and ferritin with indicate renal failure related anemia 3) What is the cause of pleural effusion Pleural fluid tapping and investigation and HRCT chest will help in diagnosis In addition other blood parameters such as liver function test, urine routine, electrolyte will further help in evaluation

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Diabetic and hypertensive pt presenting with sob Xray chest shows homogeneous opacity rt lower zone suggestive of pleural effusion Pt is severely anaemic having sr creatinine 5.8mg suggest CKD Adv tapping for diagnostic and therapeutic treatment Pt needs to evaluate the renal disease eGFR to be calculated Aged pt control diabetes and hypertension Diuretics and specific treatment for pleural effusion after analysis report Also adv for covid testing

Thanx dr Sandeep Ghodekar
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DM with CRF with Reactive anaemia with Pleural effusion R/O TB, COVID 19 Pleural tapping for therapeutic & diagnostic purposes Electrolytes, RFT, TFT, eGFR. USG Treat with Diuretics, Inj Erythropoitin PD may be started ORS just to rehydrate Pre & probiotics Zinc Antibiotic

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Left side massive pleural effusion with HTN and DM2 Patient suffering from CKD also Tapping needed and work up for Koch's Higher Antibiotics and blood transfusion

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Rt sided moderate pleural effusion seen. Rt parahilar lobulated opacity seen. Adv diagnostic and therapeutic pleurocentesis. CT thorax.

Rt sided pleural effusion

Needs pleural tapping,send sample for AFB and CBNAAT
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Pleural effusion left side. Pleural tap and investigate for ADA, fluid protein, LDH.Also fluid gram stain, zn stain, culture. CKD. Pleural effusion is present in CKD too. In CKD effusion need not be tapped unless massive. Give blood transfusion.BP? Blood Investigation including serum electrolytes,uric acid,ABG.Give hematinics, inj erythropoitin, t lasix ,amlodepine if hypertension.

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Collapse right lower lobe with pleural effusion Calcified aortic knob. CKD ABG, Abdominal ultrasound to confirm CKD ,CT chest Patient with CKD with diarrhea, may have hypokalemia and hyponatremia. Suggest pleural aspirate for analysis. Investigations for anemia,? Renal anemia . Blood transfusions , supportive measures

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Pleural effusion on rirgt must be TB.