1.

A CASE PRESENTATION
ON
“AKI with B/L PE”

. .

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 DEFINITION:
AKI is a sudden episode of Pleural Effusion is the build-up of
kidney damage that excess fluid between the layers of
happens within in a few
hours or a few days the pleura outside the lungs.

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PATIENT DETAILS:
A 55 years Old female patient was admitted in Government Hospital, Chittoor
with I.P No: 2022090917

CHIEF COMPLAINTS:
• Dyspnea(Grade-IV)
• Decreased Urine output

HISTORY OF PRESENT ILLNESS:

The patient has been suffering from the above mentioned complaint for the past
1 month
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PAST MEDICAL HISTORY:
K/C/O T2DM *20 years

PAST SURGICAL HISTORY:

Amputation of Left lower Limb 1year ago

PAST MEDICATION HISTORY

Metformin 500 mg BD

PERSONAL HISTORY:
• Mixed diet
• Attained Menopause
• Sleep and appetite - Normal
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GENERAL EXAMINATION:
The patient was Conscious, Coherent and Oriented
PHYSICAL EXAMINATION:
• Pallor- Yes
• Icterus- No
• Cyanosis- Yes
• Clubbing- No
• Lymphadenopathy- No
• Edema- No
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 DAILY VITALS CHART
D1 D2 D3 D4 D5 D6 D7

B.P.(mm of Hg) 140/90 130/90 110/90 120/80 120/80 110/80 120/80

98.4 98.2 98.6 98.2 98.2 98.4 98.2

Temperature(°F)

110 104 98 96 87 85 83
Pulse Rate(bpm)

Respiratory Rate 23 24 22 20 21 18 17
(bpm)
94 96 97 99 99 98 99
SpO2(%)

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SYSTEMIC EXAMINATION:
• RS- B/L Wheeze, Fine crepts ⊕

• CVS-S1,S2 ⊕ , No Murmurs

• CNS-NFND

• P/A- Tenderness⊕ , (Rt & Lt Lumbar region)

PROVISIONAL DIAGNOSIS:
? Breathlessness under evaluation

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 LABORATORY INVESTIGATION:
TEST TEST VALUE NORMAL VALUE
RBS (mg/dl) 160 70-140 md/dl
Sr. Bil (Total) 0.5 0-1.0mg/dl
Serum creatine (mg/dl) 5.6 0.6-1.2mg/dl
Blood Urea (mg/dl) 141 15-40mg/dl
Haemoglobin (gm/dl) 8.6 12-16 gm/dl
RBC 3.98 4-6 million cells/cumm
WBC (cu mm) 19,800 4500-11000
ESR 42 0-29 mm/hr
PLT 3.5 1.5L-4.5L
SGOT 15 <40 IU/L
SGPT 18 <40 IU/L
ALP 53 42-98 IU/L

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SPECIAL INVESTIGATION:
USG-ABD report revealed that the patient had manifested with
CT-Chest report revealed that the patient had
• Hydronephrosis
manifested with:
• ↑Renal cortical Echogenicity
•• Mild
B/L Pleural effusion
B/L kidney swelling
• ↑Resistance
B/L diffusedindex
Pleural
of thickening
Intra-renal in parietal &
arteries
• Stenotic lesions & Renal calcification absent
visceral Pleura

FINAL DIAGNOSIS:
Based on the above findings the patient was diagnosed with
“AKI with B/L PE” 9
 OVERVIEW OF THE CASE

DRUG(METFORMIN)

29 cases were
↑ Plasma Conc of metabolic end product identified
75.7% cases were
identified

Metabolic Acidosis B/L PE

AKI Fluid Overload ↑ capillary permeability of pleura

GENERIC NAME
PLAN
BRAND NAME INDICATION FQN ROA DOSE D(1-10)
CEFTRIAXONE MONOCEF ANTIBIOTIC BD PO 1gm 

SODIUM BICARBONATE NODOSIS ALKALINISER TID PO 500mg 

IPRATROPIUM DUOLIN BRONCHODILATOR TID INL 500mcg/ 
BROMIDE+LEVOSALBUTAMOL To Treat the signs and symptoms 1.25mg
METFORMIN GLYCOMET OHA BD PO 500mg 

BUDESONIDE BUDECORT ANTI-INFLAMATORY BD INL 0.5mg 

PANTOPRAZOLE PROTONIX GI PROPHYLAXIS BD PO 40mg 
FUROSEMIDE GOALS LASIX DIURETIC OD IV 40mg 
AZITHROMYCIN Z-MAX To Reduce the ADRs BD
ANTIBIOTIC PO 500mg 
TELMISARTAN TELMA ANTI-HYPETENSIVE OD PO 40mg 
FERROUS FUMARATE/ FOLATE LIVOGEN IRON SUPPLEMENTS OD PO 45/0.4mg 
O2 Inhalation O2 SUPPLEMENT BD INL 2L/min 
NORMAL SALINE WITH MULTI VITAMIN ELECTROLYTE BD IV 1 PINT 
To improve the QOL
REPLENISHER

Discharge Advice: WITH THE SAME MEDICATION IN CHART FOR 5 DAYS AND TO REVIEW IN OP 30DAYS

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 SOAP ANALYSIS:
SUBJECTIVE FINDINGS:
• Dyspnea(Grade-IV)
• Decreased Urine output
• K/C/O T2DM *20 years

OBJECTIVE FINDINGS:
• RBS-160 mg/dl
• Sr.Cr-5.6 mg/dl
• Blood Urea-141mg/dl
• CT Chest- B/LPE

ASSESSMENT: AKI with B/LPE

PLAN: Medical Management

 PRESCRIPTION ANALYSIS:

↓Urine Output

Metabolic Acidosis

Hence, the prescription is found to be 5

“IRRATIONAL”
PHARMACIST INTERVENTION :
 PATIENT COUNSELLING:
DISEASE INFO DIETARY APPROACH
This is a condition in which • ↓Proteins, carbohydrate,
kidney doesn’t function fat containing foods
normally and lungs build up • ↑Fiber foods
more water. • Fluid >2L/day

DRUG INFO LIFESYLE CHANGES

• Pantop – ½ hr before • Mild exercise -30 mins
food Walk- 5 days/ week
• Don’t skip medication, • Sleep-7-8 hours
follow as per order • Breathing Exercise
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