Case disscussion

30 year Female admitted through emergency with history of septic abortion managed in some private hospital and reffered here for the oligouric renal failure.

According to the attendant, patients was alright till 5^th month pregnancy, then experience fever, high grade in nature. For which she consulted local doctor who prescribed some medication following which she had bledding per vagina. She went to hospital which septic abortion was diagnosed and subsequently evacuated. Following which she went into loigouria/anuria. Renal function got deteriorated and she started becoming restlessness and short of breath and finally she was reffered here.

Regarding her past history, she has 5 other children who all were born in home except last one who required C/section as the case was not handled by Dai ( Health care provider). In all those deliveries ware uneventful so as tenure of pregnancy.

There is no significant past history of note either medical or surgical.

There is no drug history.

Personally no addiction mentioned.

On examination: She was conscious but restless.

She had regular pulse 108 bpm

Apyrexial

BP was 79/42 mmhg

Respiratory rate 32 breath per minute.

She was pale but not icteric, not cyanosed. There was no clubbing and no koilynyckia. Peripheries were dry and JVP was positive.

Abdominal examination show distended symmetrical abdomen, soft with diffused mild tenderness. No viscera were palpable.

Chest was clear.

CVS: both S1 and S2 were audible in all four  areas with no significant difference of intensity. No murmur or rub notice.

CNS was grossly normal.

My conclusion was Acute renal failure following Obsteterical Problem( Septic Abortion). She can have ATN/CAN secondary of sepsis or some hemodynamic instability during the procedure of evacuation.

Management:

She was admitted in High dependency care.

Iv line maintained.

Follys catherized.

CP, MP , UCE, Blood culture, urine Dr and C/s If urine comes.

Chest xray and Arterial blood gases were ordered. LDH and Lft were also requested.

On basis of above DL cather was passed and she was dialysed.

Still admitted.

Labs: HB 9 mg/dl

Tlc 1100

platelets 32000

S.Creatinine 3.7

severe metabolic acidosis in ABGs.