AKI case Presentation

1. CASE PRESENTATION
By Muhammad Saleh
Fcps Part 2Trianee
Department of Pediatrics
GMMMC Hospital sukkur

2. HISTORY
 5 Months old child namedYasir Ali weighs-4.7
kg, resident of Mahjipur Admitted via
Pediatric Emergency on 01-12-2021 on bed no
06 with the following chief complaints
 Fever , loose motion and shortness of breath
for 1 week
 Fits and decrease urine output for 02 days

3. History of Presenting
complain
 According to statement of patient’s Mother He was alright
one week back then He developed fever, which was sudden
in onset, high grade in intensity, continous in nature and
not associated with rigor and chills.Fever was associated
with shortness of breath which was progressive in nature ,
present throughout the day ,causes difficulty in
breastfeeding but not associated with cough and
cyanosis.Patient also complaint of loose motion, which
were watery in consistency, yellow in colour , foul smelling
about 9-10 episodes in 24 hours without any blood or
mucus
 For these complaints they went to general physician who
prescribed them IV antibiotics.

4. continued
 Patient developed Fits 02 days back which were
Generlized tonic-clonic. Each fit lasted for about 5-
10 minutes and 2-3 Episodes per day associated with
Uprolling of Eyes and Urinary incontinance but not
associated with loss of conciousness , feacal
incontinance and frothing from Mouth.
 Patient Also had decreased urine output noticed by
Mother since last 02 days, changing 01 Diaper in 24
hours, yellowish in colour.
 Due to these complaint they went to JIMS
Jacomababd where He was admitted for one day
and some blood reports were done than Patient
referred to GMMMC hospital Sukkur

5. Sytematic Inquiry
 GIT:Complaints Of Diarrhea , while No
complaints ofVomiting , Abdominal
distension and Melena
 Respiratory:Complaint of Shortness of breath
but No history of cough and Hemoptysis
 CVS:No complaint of Palpitation
 Genitourinary:Complaint of Oligouria but No
history of hematuria
 CNS:complaint of Fits, No history loss of
conciousness, weakness or loss of vision

6. Past History
 No Any Medical or Surgical Past history

7. Birth History
Antenatal
 5Th issue
 Unbooked
 Unvaccinated
 No drug history other than Multivitamins
 No history of HTN, GDM or fever

8. Natal
 Born via SVD at Home By dai 38 weeks of GA
 No Hx of PROM or prolonged labour

9. Post Natal
 Cried immediatly after Birth
 No hx of Respiratory distress , cyanosis ,fits or
rashes
 Umbilical cord cut with Blade
 NO NICU Admission reported

10. Feeding History
 Baby is on Breast feed and Formula feed
Breastfeed frequency 8- 10 times Per day
Formula feed frequency 2 bottles Per day
Mother cleans the Bottle once in 24 hours

11. vaccination history
 Not Vaccinated

12. Developmental history
 Milestone Achieved upto age
 Like Neck holding, social smile, turn to
nearby voices.

13. Family History
 Product of Cousin marriage
 He has 3 Brothers and 1 Sister
 All are alive and healthy
 No previous history of miscarriage, stillbirth

14. Socioeconomic history
 Father is Farmer by occupation
 Lives in Mud Made House , 2 rooms
 Well ventilated
 They use hand pump water for Drinking

15. EXAMINATION

16. General Physical Examination
 5 Month old child , ill looking Edematous,
cathetrized and cannulated on right hand having no
any dysmorphic features, seems to be in Rapid and
deep breathing with the followingVitals
 R/R- 64br/min
 HR-95 beats/min
 Temp:102f
 BP:90/60 mmhg
 ( Systolic below 90th centile and distolic above 95th
centile)
 CRT: delayed

17. Sub vitals
 Anemic
 Edema over feet which were pitting
 Skin pinch goes very slowly
 Jaundice and cyanosis is negative
 On Head to toe examination: Anterior fontanelle
soft and and open slighlty depressed ,Hair were thin
sparse easily pluckable, skin was dry and thick.
 On eye examination: no bitot spot , corneal
ulceration or dry conjuctiva.
 On mouth examination:there were oral thrush ,No
mouth ulcer, anguler stomatitis, cheliosis or bleeding
gums.

18. Continued
 On examination of Skin there were
hypopigmentation over Perianal region,
greenish spot at cannulated sities on right
elbow feet and hands
 Dark Red Patch at right and left knee around
2.5 cm.

20. Anthroprometry
 OFC: 38cm (below 3rd centile)
 Weight:4.7kg (Below 3rd centile)
 Length: 58cm (Below 3rd centile)
 MUAC:10.5cm

21. Chest Examination
 Inspection:Shape of chest Elliptical, No chest
deformity, pulsation, scar or visible bulging
present.
 Palpation:Trachea was centrally located ,
there were no any tenderness, chest
movements were equal on both sides
 Auscultation:Breath sounds are of normal
intensity and vesiculer, there is bilateral equal
air entry

22. Abdomen
 Inspection:No Prominent veins , pulsations or
any scar mark Present, umbilicus is centrally
located
 Palpitation: No tenderness on palpitation , total
liver span was 6 cm smooth surface soft in
consistency and round margins
 Urinary bladder were not palplable
 Percussion : Shifting dullness and fliud thrill
negative
 Auscultation:Normal bowel sound and no any
bruit noted

23. CVS
 Apex beat in 4th Intercostal space
 S1+s2+0
 Pulse: low volumic and reguler in rthym

24. CNS
 Higher Mental function:Well oriented with
time , place and Person
 GCS:E4M6V5 15/15

25. Motor Examination
 RLL LLL
 Bulk Normal Normal
 Tone Normal Normal
 Power 5/5 5/5
 Reflex Normal Normal

26.  RUL LUL
 Bulk Normal Normal
 Tone Normal Normal
 Power 5/5 5/5
 Reflexes Normal normal
SOMI negative

27. Genitourinary
Musculoskeletol
unremarkable

28. Case summary
 5 month old child named yasirAli weighs:4.7kg, unvaccinated ,
Resident of Mahjipur Admitted via Pediatric Emergency with complaint
of
 Fever , loose motion and shortness of breath for 1 week
 Fits and decrease urine output for 02 days
 On GPE patient is ill looking edematous seems to be in rapid and deep
breathing having cannula on right hand with following vitals
 R/R-64/min Anaemic
Pitting Edema over feet
 HR:95 beat/min Skin pinch Shows severe dehydration
 Temp:102f
 Other Positive finding
 There were hypopigmentation over perianal region , greenish spot at
cannulated sites on right elbow , feet and hand
 Dark red patch at right and left knee around 2.5 cm

29. differential diagnosis

30. Sepsis with Complications
AKI Secondary to Acute
Gastroentritis
Hemolytic Uremic syndrome

31. CBC
 Hb:9.2
 RBC:4.10*10^12
 Hematocrit:28
 MCV:80.8
 MCH:24.9
 MCHC:30.8
 TLC:36000
 Neutrophil:75%
 Lymphocyte:20%
 Eisinophil:2%
 Monocyte:03%
 Platelets:260000

32. CRP: 60
PT:40
Aptt:55
INR:3.6

33. Urea/creatinine/Electrolye
Urea: 212
Creatinine:1.08
Sodium: 125
Serum potassium:2.5
Serum chloride:145
Serum bibarbonate:15

34. CSF Dr – Unremarkable
CSF- awaited
Blood culture_Awaited
-

35. diagnosis
 Sepsis with Complications