My mom's health has deteriorated completely in a year. Please help.

Question

Hi doctor,

My mother is 56 years old. She has been a diabetic for the last 20 years. Her health has deteriorated completely in the last year. We found out through a biopsy that her kidney has been damaged.

Her gallbladder was removed as it was infected and had a stone as big as a marble. The mouth and the upper layer of the pancreas had ulcer wounds for which she was treated with medication three months ago. She is having indigestion, acute stomach pain, swelling from feet to waist, frequent diarrhea, and vomiting. She has been urinating only about 15 mL.

The doctor has suggested starting dialysis as they are unable to bring her swollen feet under control. Her blood pressure is normal. I have uploaded her recent test results. She is currently taking 21 tablets a day. I basically need some suggestions.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing the details.

Based on the reports provided, she has hypoalbuminemia, which means the albumin level in her blood is low. Albumin is an important protein that helps maintain fluid balance in the body. Her serum potassium level is also elevated (hyperkalemia), which requires prompt attention because significantly high potassium levels can affect heart function.

At this stage, the priority is to manage the elevated potassium level under close medical supervision. Treatment may include medications such as diuretics, insulin with glucose infusion, calcium gluconate, and potassium-binding resins. If the potassium level remains above the safe range despite treatment, dialysis may need to be considered.

I would like to review her kidney biopsy report, if available, as it can provide valuable information about the underlying cause of her kidney disease.

The most likely diagnosis is chronic kidney disease (CKD) related to diabetic nephropathy, especially if she has a history of type 2 diabetes. However, other conditions such as nephrotic syndrome and uremia should also be considered.

I recommend regular monitoring of the following:

Serum potassium.
Serum creatinine and kidney function tests.
Thyroid-stimulating hormone (TSH).
Lipid profile.
Ultrasound abdomen to assess the size and corticomedullary differentiation of the kidneys.

In addition, treatment with 20% albumin infusion may be considered if clinically indicated and advised by her treating physician.

Dietary precautions are also important:

Restrict salt intake as advised by her nephrologist.
Avoid foods that are high in potassium.
Follow a kidney-friendly protein intake plan based on her body weight and stage of kidney disease.

Since elevated potassium can become a medical emergency, I recommend close follow-up with her nephrologist and immediate medical attention if she develops symptoms such as muscle weakness, palpitations, chest discomfort, or worsening shortness of breath.

I hope this information helps.

Please feel free to reach out if you have any further questions.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I have read your query.

In previous reports (attachments removed to protect the patient's identity), serum potassium was 6.6 mg/dl. But potassium in this report has decreased from 6.6 to 5 mg/dl. I do not think that she requires dialysis at present.

Give her injection Dytor (Torasemide) 2 ampules IV twice daily, and I also request her treating doctor to add tablet Sevelamer 400 mg thrice daily. Consult her specialist doctor, discuss with him or her, and take the medicine with consent.

Please tell me about her Hb levels.

Revert back with the additional details to a nephrologist online.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

Based on the information provided, the elevated potassium level is most likely related to the progression of her chronic kidney disease (CKD), as impaired kidney function can reduce the body's ability to eliminate excess potassium.

The immediate priority is to bring the potassium level down under close medical supervision. Treatment may include medications such as Torasemide (Dytor), insulin with glucose infusion, calcium gluconate, and potassium-binding resins such as sodium polystyrene sulfonate (Kayexalate).

If her potassium level remains elevated despite these measures, it may indicate refractory (resistant) hyperkalemia, in which case dialysis becomes the most effective treatment option to rapidly remove excess potassium and prevent potentially serious complications.

I recommend monitoring:

Serum potassium levels regularly.
Serum magnesium levels.
Kidney function parameters as advised by her nephrologist.

The most likely diagnosis is:

Chronic kidney disease (CKD) with associated hyperkalemia.

In the meantime, she should:

Strictly avoid foods that are high in potassium.
Follow the dietary recommendations provided by her nephrologist or renal dietitian.
Continue regular follow-up and laboratory monitoring.

Because high potassium levels can affect the heart, prompt medical attention is required if she develops symptoms such as palpitations, chest discomfort, muscle weakness, or worsening fatigue.

I hope this information helps.

Please feel free to ask if you have any further questions.

Thank you.