vinay kumar a v

Consultant Nephrology APOLLO BSP.

[vinay kumar a v @vinaykumarav]

9. in this case, cardiac tamponade causing obstructive shock—led to acute kidney injury and anuria. AKI is often a manifestation of systemic pathology rather than primary renal disease. In nephrology, understanding the heart is often just as important as understanding the kidney.

[vinay kumar a v @vinaykumarav]

1. When Anuria Was a Cardiac Emergency:

An interesting case from the CTVS ward involved a 58-year-old gentleman with a history of type 2 diabetes mellitus, hypertension, and coronary artery disease.

[vinay kumar a v @vinaykumarav]

8. Within one hour urine output started at 30 mL/hour and progressively increased to 150 mL/hour. Patient entered diuretic phase and had complete renal recovery in next 3 days. This was a classic example of Type 1 Cardiorenal Syndrome (CRS-1), where acute cardiac dysfunction—

[vinay kumar a v @vinaykumarav]

7 Emergency pericardiocentesis done, and 700 mL of serous pericardial fluid drained. There was immediate normalization of the arterial waveform, restoration of pulse volume, and a significant improvement in BP 160/90 mmHg. Norad was subsequently tapered and discontinued.

[vinay kumar a v @vinaykumarav]

6. Arterial waveform showed marked respiratory variation in pulse amplitude, with a progressive decrease in pulse volume during inspiration—classical pulsus paradoxus. (?cardiac tamponade). An urgent echo showed a localized pericardial collection, predominantly adjacent to the LV

[vinay kumar a v @vinaykumarav]

5. Combination of hypotension, anuria, and evidence of volume overload, cardiogenic shock was suspected. The patient was immediately shifted to the ICU, started on noradrenaline infusion, and an arterial line was placed for continuous hemodynamic monitoring.

[vinay kumar a v @vinaykumarav]

4. Laboratory investigations showed:

- Serum creatinine: 2.6 mg/dL
- Sodium: 127 mEq/L
- Potassium: 6.6 mEq/L
- Chloride: 112 mEq/L
- Hemoglobin: 10.2 g/dL
- Total leukocyte count: 8,000/mm³
- Platelet count: 2.1 lakh/mm³
- Procalcitonin: within normal limits

[vinay kumar a v @vinaykumarav]

3. Following admission, his urine output rapidly declined, and within 24 hours he developed complete anuria.

He was hypotensive with BP of 90/60 mmHg and had feeble peripheral pulses. facial puffiness, elevated JVP, and gen edema involving were noted.

[vinay kumar a v @vinaykumarav]

2. CAG revealed triple-vessel disease, for which he underwent CABG three weeks earlier. He was discharged after an uneventful postoperative stay of 10 days.

Seven days after discharge, he presented with progressive bilateral lower limb edema, facial puffiness, low urine output.

[vinay kumar a v @vinaykumarav]

This was the first episode of Hemolysis, patient had experienced.

First G6PD deficiency case presenting with AKI I have seen in Chhattisgarh in past 6 years.

Patient completely recovered from AKI and was discharged home in stable condition.

[vinay kumar a v @vinaykumarav]

1/6 Midnight Emergency Case 🩺🌙

1/ A 21-year-old male presented at midnight with:
🤕 5 days abdominal pain
🩸 Hematuria
😣 Uneasiness
Vitals:
BP 120/80
Pulse 100
RR 30/min
SpO₂ 68% (↑ to 73% on 6L O₂)
👀 Icterus
🫁 Chest X-ray: Clear

[vinay kumar a v @vinaykumarav]

6/6 Final Diagnosis:

🧬 G6PD deficiency
+
🩸 Acute hemolysis
+
🟤 Methemoglobinemia
+
🧪 Hemoglobinuria
+
🩺 Dialysis-dependent AKI.

A dramatic example of oxidative crisis in G6PD deficiency.

#MedTwitter #FOAMed #CriticalCare #InternalMedicine

[vinay kumar a v @vinaykumarav]

5/6 What happened?

🧬 G6PD deficiency
⬇
🔥 Oxidative stress
⬇
💥 Massive intravascular hemolysis
⬇
🩸 Hemoglobinuria
⬇
🧪 Acute Kidney Injury
Hb dropped from 14 ➝ 4 g/dL in 3 days 😱
Dialysis dependent for 2 weeks.

[vinay kumar a v @vinaykumarav]

4/6 Further workup:
LDH 📈 2500
Retic count 🔄 5%
Peripheral smear:
🍎 Bite cells
🫧 Blister cells
💥 Schistocytes
G6PD test ➝ ✅ Positive

[vinay kumar a v @vinaykumarav]

3/6 Co-oximetry confirmed:
🟤 Methemoglobin = 10%
Given 💙 Methylene blue 1 mg/kg

❌ No improvement in saturation

That was the turning point.

[vinay kumar a v @vinaykumarav]

2/6 ABG results:
PaO₂ 💨 315
SaO₂ 📊 99%
pH 7.44
HCO₃ 20
Creatinine 🧪 6.8
Low SpO₂ + very high PaO₂ = 🚨 Saturation gap
👉 Suspected methemoglobinemia

[vinay kumar a v @vinaykumarav]

@makemytrip @makemytripcare Makemytrip has not processed refund inspite of recieving refund from indigo... And they have provided a false RRN number also

[vinay kumar a v @vinaykumarav]

@makemytrip @makemytripcare
Makemytrip charges convenience fee .. however no convenience is provided. Even after Indigo has processed refund on the same day Indigo has not provided the refund ... And there is no way to talk to customer care executive... AI BOT just repeats same

[vinay kumar a v @vinaykumarav]

useless reply.

Booking id - NF7AI4QP87167246083

Atleast don't steal innocent customer money.