Dr. Anshul Varshney
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My uncle, 73 years old was suffering from multiple myeloma. As a result, he had problems with Opioid-induced bowel dysfunction. And also, he had recently undergone surgery regarding resection in the small intestine and being on a ventilator. So now he has renal failure. Both kidneys were already failing before the surgery. There is zero kidney function. He is undergoing dialysis daily. He has swelling all over his arms, feet, knees, and hands. Looking like ready to pop. Several liters of fluids were removed from his system daily, but it is not helping him.
How much swelling the body can bear?
Are there any additional ways to remove the fluids more effectively?
The rural hospital he was admitted in does not offer a cart, and even do not know whether it would make much difference. Still, now he is in very critical condition to get shifted. His nephrologist and cardiologist do not seem to agree on the best approach. Thinking about the loss and wondering whether he is getting the most comprehensive care or he needs a better one.
Please help!
Hi,
Welcome to Icliniq.com.
I can understand your concern. I have gone through your reports (attachment removed to protect the patient's identity). He has an acute or chronic infection. The swelling over the body happens as a result of the following:
1. Fluid retention.
2. Anemia.
3. Protein deficiency.
All this happens in kidney diseases. The best approach I would recommend here would be hemodialysis three times a week with good ultrafiltration while giving oral diuretics daily. Maintaining his hemoglobin around 10 mg/dl. We do not aim much high in kidney diseases. Also, here it is important to treat any other infections present. He may require a few sittings of daily dialysis when he shows improvement. Continuous renal replacement therapy would make much difference at this point in time. I suppose the treatment being offered must be the best as per the situation. Since it is a complicated matter, you need to keep patience.
I hope it helps you.
If you have any further queries, please ask me.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
This is very helpful. My uncle did indeed have an infection present, too: post-operative sepsis. As well, his bowels ruptured before surgery.
Thank you.
Hi,
Welcome back to icliniq.com.
Diuretics can be given in injectable forms. And I suppose they must be given if his blood pressure is stable. So, it looks to be a sepsis-induced acute kidney injury. I suppose every doctor tries their best, and your doctors must be doing that, I am sure. But, yes, he has multiple complications, and the prognosis is not good.
I hope it helps you. If you have any further queries, please ask me.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
Hi,
Welcome back to icliniq.com.
I wish him a speedy recovery.
Thank you.
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Internal Medicine
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