Dr naglaa shafik case

1. .

2. .
42 years old female house wife. from
Elmahalla Elkobra . Married and have one
offspring
Personal history

3. Present History:
Patient is 25 w of pregnancy G5P1A3.
Hypertension was discovered one year
ago on aldomet 250 bd and labetalol 200
bd .
Patient presented by severe bilateral
pitting lower limb oedema and AKI

4. Complain
Patient came to ER complaining with
bilateral severe swelling in both LL scince
one month.

5. Past history
 Gestational hypertension in all her previous
pregnancies.
 During her only successive pregnancy ,she was on
heparin and low dose aspirin and delivery was by C.S.
 She had 3 abortions, the first two abortions was at 6
months of pregnancy , the third one was at 40 days

6. Examination :
Patient is Fully conscious , oriented and
cooperative .
ABP 130/80mmhg , HR 90 beats/ min regular
equal pulse. RR 18 cm Temp 37.
LL : bilateral pitting oedema above knee.
Chest: harsh vesicular breathing .

7. INVESTIGATION on admission
S creatinine : 6 mg/dl
B urea:139 mg/dl
S Na :143 mmol/L
S K:4.5 mmol/L
INR : 1.12
Uric acid : 11.3 mg/dl
A/C ratio : 10.5 g
C3 : 104 (90-170) C4: 35 (12-36)

8. ABG PH:7.38
HCO3: 6.5mmol
PCO2: 11mmol
CBC Hb:9.7 gm/dl
WBCs:6.7x103 cells/mcL
RBCs:3.15 million cells/mcL
PLT: 244000
Albumin: 3 SGOT : 42 SGPT : 40
Ca : 7 mg/dl po4 : 8.1 mg/dl
T bilirubin : 0.7

9. Urine analysis show:
Pus cells : over 100
RBCS : 5-7/ HPF
Granular cast: +

10. ABDOMINAL US:
Liver and spleen: average size
Rt kidney : increase echogenicity Grade 2
LT kidney: : increase echogenicity Grade3
Obstetric U/S: gravid uterus with single living fetus
25 wks adequate amniotic fluid
.

11. management
1.antihypertensive : aldomet 250 tds labetalol 200
tds .
2.Fluid chart
3. Heparin 5000 iu bd
4. Unacyn 1.5 g bd
5. Ceftriaxone 1 g once per day
6 . At the fifth day of admission Rt jagular catheter
insertion and daily dialysis started

12. Fluid chart
 First patient was oliguric 400 ml/24 h

13. Care of hypertension
 Blood pressure not responding to medications
 Average blood pressure measurements was
180/100
 So decesion of termination was taken on the
eighth day of admission by C.S
 Baby died after delivery
 Mother transferred to ICU after delivery for
three days then BP 150/90 and good UOP
and stop dialysis

14. On discharge
S creatinine : 3.2 mg/dl
B urea: 86 mg/dl
S Na : 133 mmol/L
S K: 4.4 mmol/L
CBC Hb:9.4 gm/dl
WBCs:9.7x103 cells/mcL
PLT: 194000