A 50/M with nephrectomy and uncontrolled hypertension CBBLE UDHC similar cases

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Chief complaints

Came for colostomy reversal

History of presenting illness

On 6/1/2020 - got operated for left sided kidney (left PCNL with DJ stenting) for left sided emphycematous pyelonephritis secondary to renal calculi at PUJ junction (2.8mm)

On 18/8/2021 - patient God dtpa scan and revealed left-sided kidney hydronephrotic with severe parenchymal dysfunction

Patient got left nephrectomy in a hospital on in October 2021, followed by colostomy in view of chronic injury

Case reviewed in view of uncontrolled hypertension, BP 220/120 with fluctuating trims decrease with epidural anaesthesia patient 

complains of pain at drain site at left iliac and left lumbar did not decrease with analgesia and burning sensation present at suture site.

Vitals

PR - 90/min, regular

BP - 200/100

CVS - JVP normal, Apex 5th ICS, pan systolic murmur (TR) more in tricuspid area

RS - BAE +, NVBS

RR - 25/MIN, 

SpO2 97% on RA

Clinical images

Surgical drain

RFT

UREA 46

CREAT 1.4

NA 147

K 4.0

ABG

PH 7.3

PCO2 36

PAO2 140

HCO3 17.4

A.G 15.8

HEMOGRAM

HB 14.6

TC 8,600

PLT 2.3

Serology

HIV, HBSAG, HCV negative

LFT

TB 0.65

DB 0.2

AST 14

ALT 9

ALP 174

TP 6.1

ALB 3.2

CUE

ALB TRACE

SUGAR NIL

PC 3-4

EC 2-3

Coagulation profile

BT 2-30

CT 5-00 MIN

APTT - 33

BGT

B POSITIVE

ECG

2D echo

Moderate aortic regurgitation 

trivial tricuspid regurgitation 

no mitral regurgitation 

no RWMA

no mitral stenosis 

mild aortic stenosis 

sclerotic AV 

good LV systolic function 

diastolic dysfunction present 

no pulmonary artery hypertension

Treatment

T. NICARDIA 20mg RT STAT

T. CLINIDEPINE 10MG RT OD 8PM

IVF NS/RL U.O + 30ML/HR

REVIEW AT 6PM

BP 200/120

T. NICARDIA 20MG RT STAT GIVEN AT 5PM

NTG INFUSION 2AMPOULES + 40ML 5DW 1MG = 1ML @ 6ML/HR

DAY 2

Ryle tube aspirate

Continue NTG till 5 PM WITH DOSE TITRATION

T. CLINIDIPINE 10MG PO OD

AT 7 PM

BP 160/90

PR 85 BPM

CVS - JVP normal, Apex 5th ICS, pan systolic murmur (TR) more in tricuspid area

RS - BAE +, NVBS

RR - 25/MIN, 

SpO2 97% on RA

FENTANYL PATCH / FENTANY INFUSION FOR PAIN MANAGEMENT

T. ALPRAZOLAM 0.25 MG RT HS

DAY 3

S

NO FRESH COMPLAINTS

O

Patient had hypertension with blood pressure of 60/40 at 11:00 p.m. on 12th March when epidural defecation was given and IVF 500 ml bolus was given and BP was 100/80

A

Pt is C/C/C

BP 160/80

PR 84/MIN 

CVS - JVP normal, Apex 5th ICS, pan systolic murmur (TR) more in tricuspid area

RS - BAE +, NVBS

RR - 25/MIN, 

SpO2 97% on RA

S. Amylase 71

S. Lipase 20

Input 2300ml

Output 1700ml

RFT

S. Urea 47

S. Creat 1.8

S. Ua 3.8

Ca 10

Na 134

K 4.1

Cl 99

LFT

TB 1.43

DB 0.3

AST 20

ALT 12

ALP 115

TP 5.6

ALB 3

P

T. Cilnidipine 10mg RT BD

T. ALPRAZOLAM 0.25 mg RT HS

Day 3

 

S
No complaints of vomitings

O

pt is c/c/c

BP - 

rt arm 160/80 mmhg, 5 pm 170/80 mmhg

lt arm 160/90 mmhg 

PR 70 bpm

CVS - JVP normal, Apex 5th ICS, pan systolic murmur (TR) more in tricuspid area

RS - BAE +, NVBS

RR - 25/MIN, 

SpO2 97% on RA

P

T. Cilnidipine 10mg RT BD

T. arkamine 0.1mg PO stat

T. arkamine 0.1 mg PO OD 1pm

T. ALPRAZOLAM 0.25 mg RT HS