A 39 year old man presented with complaints of abdominal distension, bilateral pedal edema, and decreased urine output .

A 39 year old man presented with complaints of abdominal distension, bilateral pedal edema, and decreased urine output since 20 days.

Patient works in vegetable market and has 2 children(1 son and daughter) .History of fever since 20 days on and off for 3 days. Patient earliest recall of events dated 20days back, where he attended a marriage, his symptoms started after intake of alcohol. He developed low grade fever for which he used medication for 2-3 days and noticed abdominal distention on not subsiding.They visited gastroenterologist and was advised admission.The patient denied any admission as he would continue medication on opd basis.

2 days later on further worsening he was admitted in another hospital and was told he had kidney infection (in his words ) and was admitted on not improving and with increasing trend of creatinine levels,the patient was advised dialysis and was reffered to kamineni.

History of alcohol intake present since 15 years which is around 3-4 times a week amounting to 129 ml of whisky or a pint of beer.

h/o smoking since 15 years 1-2cigarretes/day.

General Examination: Patient is c/c/c

pallor -

icterus -

clubbing -

cyanosis -

lymphadenooathy -

edema -

vitals

temp-afebrile

Bp-110/70

PR-74

RR- 18

spO2-98%

grbs- 139mg/dl

Systemic Examination:

CVS: S1S2heard

RS: bilateral IMF, ISF

PA: soft, No tenderness, bowel sounds +

CNS: Pt. is conscious, CNS intact

Investigation:

Serum amylase: 26.3

Urine protein :42.6

Creatinine:32.6

Protein/creatinine :1.3

Diagnosis :

?AKI (secondary to sepsis) with alcoholic liver disease.

Treatment:

Day1:

Oxygen supplementation if spO2< 90%

Salt restriction<2.4 gm/day

IVF 2 NS and 1 DNS 75 ml/hr

Inj. Pan 40 mg IV OD BBF

Inj.Lasix 40 mg IV BD

Inj.Thiamine 1 amp.in 100 ml NS IV TID

Day 2

Oxygen supplementation if spO2< 90%

Salt restriction<2.4 gm/day

IVF 2 NS and 1 DNS 75 ml/hr

Tab.Monocef 200 mg PO/BD

Inj. Pan 40 mg IV OD BBF

Inj.Lasix 40 mg IV BD

Inj.Thiamine 1 amp.in 100 ml NS IV TID

Nebulisation with salbutamol respules/stat