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

Answered by
Dr. Abhinav Gupta
and medically reviewed by iCliniq medical review team.
Published on Aug 04, 2016 and last reviewed on: Oct 09, 2018

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. 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 suggestion.

Dr. Abhinav Gupta

Diabetology Nephrology
#

Hi,

Welcome to icliniq.com.

  • She is having hypoalbuminemia (low level of albumin in the blood).
  • Also, her serum potassium is high. We have to treat serum potassium first with diuretics and Insulin infusion.
  • If the serum potassium does not come below 5.5, then she can go for dialysis.
  • I would like to know the kidney biopsy report.

The Probable causes:

Type 2 diabetes mellitus with chronic renal failure.

Investigations to be done:

Serum potassium, serum creatinine regularly, TSH (thyroid stimulating hormone), lipid profile, ultrasound abdomen to see corticomedullary differentiation status of the kidneys.

Differential diagnosis:

1. Nephrotic syndrome.
2. Uremia.

Probable diagnosis:

Type 2 diabetes mellitus with diabetic nephropathy or chronic kidney failure (CKD).

Treatment plan:

My suggestion is to get the following treatment under doctor's supervision.
1. Albumin 20%
2. For hyperkalemia, diuretics, Insulin infusion, Calcium gluconate and potassium bind resin. If hyperkalemia does not improve, then go for dialysis immediately.

Preventive measures:

1. Salt intake should be less than 1 g per day.
2. Avoid foods rich in potassium.
3. Protein intake should be less than 0.6 g/kg body weight.

Regarding follow up:

Revert back with the reports to a nephrologist online.---> https://www.icliniq.com/ask-a-doctor-online/nephrologist

Thank you doctor,

Thanks for your prompt response. I have received some more test results. Sorry, it is not very clear as my mother is in abroad and sending from there. I hope you can give me some advice.

Dr. Abhinav Gupta

Diabetology Nephrology
#

Hi,

Welcome back to icliniq.com.

  • In previous reports serum potassium was 6.6. But, potassium in this report has decreased from 6.6 to 5. I do not think that she requires dialysis at present.
  • Give her injection Dytor (Torasemide) 2 ampule 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 --> https://www.icliniq.com/ask-a-doctor-online/nephrologist

Thank you doctor,

I have just double checked the dates. The first attachment is her latest test results and the second attachments were taken before a month. So, her potassium has gone up from 5.5 to 6.6 in a month.

Dr. Abhinav Gupta

Diabetology Nephrology
#

Hi,

Welcome back to icliniq.com.

  • For serum potassium treat her with injection Dytor (Torasemide), Insulin infusion, Calcium gluconate and Kayexalate (Potassium bind resins - Sodium polystyrene sulfonate).
  • If after this treatment still her potassium levels remain high, then it is known as resistant hyperkalemia and the treatment of choice is only dialysis.

The Probable causes:

Complication of CKD.

Investigations to be done:

Serum potassium and serum magnesium.

Differential diagnosis:

Hyperkalemia.

Probable diagnosis:

CKD.

Preventive measures:

Avoid foods rich in potassium.

Regarding follow up:

For further doubts consult a nephrologist online.---> https://www.icliniq.com/ask-a-doctor-online/nephrologist

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