شوفوا هذا الكيس اخوان ... و فكروا بيه قبل لتقروون التكملة
74 yr old F
hx of DM, HTN, IHD, old non-disabiling ischemic stroke
13 days ago, she underwent emergent lapratomy for sigmoid volvolus.
After that, she srarted to develop decrease oral intake ... till 2 days, she has anuria.
she readmitted again.
her renal indices are tripled from baseline.
considered to be pre-renal AKI over CKD.... Thus, the team started to rehydrate the pt with NS + GS.
Despite good hydration, the pt has developed oliguria with new onset dyspnia and chest crept.
لهنا الأمور تمام؟؟
the team consult nephrology unit for opinion about hemodialysis HD.
when I assessed the pt, she was in respiratory distress, bilateral chest crept upto mid zones.
POCUS: IVC ≈ 2, and collapsible.
فهنا انتةالمفروض تستحضر ال ddx. ممكن من الوهلة الأولى، و التيم يقرأ براسك، تكولةالمريضة تحتاج ديالزز و ultrafiltration، و خلص.
بس مو هيج الوضع ...
wholistic approach for this pt is
acute in hospital dyspnia with chest crepts.
ddx:
1) fluid overload (hypervolemic lungs) .... which is less likely since IVC is collapsible
2) pulmonary embolism
3) new aspiration pneumonia
4) new cardiac events
هاي الي تجي ع البال
لكن من تصفن اكثر و تدقق بالهستري ... خليت احتمالات اخرى
5) thiamine deficiency
6) refeeding syndrome precipitated by glucose infusion (hypophosphatemia)
ف بعد ما دزيت ال
basic workup
دزيت
s PO4 level ... and it was 1.33 ... very low
we stopped GW + we gave phosphate IV + empirical thiamine given + calori intake is adjusted to 1/3rd.
و انتظرنا على مهلنا ... و الأمور مشت فوق التمام
"و لله الحمد من قبل و من بعد"
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3July 17, 2026 7K 15 66
