Acute Kidney Injury (AKI) in a Young Male
in Max Smart Super Speciality Hospital, Saket
Nov 23 , 2022
A 19-year-old boy from Siliguri came to Delhi seeking college admission after graduating from high school. He had a background of smoking 12 cigarettes/day, marijuana smoking for the previous three years, consumption of spasmo-proxyvon (dicyclomine, paracetamol, tramadol combination) 2-4 tabs daily for four years, consumption of Corex (dextromethorphan and chlorpheniramine) cough syrup at two bottles of 250 ml weekly, use of whey protein 1-2 scoops daily after gym exercises.
Additionally, he consumed one litre coke daily and frequent red meat, but denied alcohol intake. His dietary intake has been poor for the past two years, with weight loss and frequent vomiting during this period.
Six days prior to the presentation, he allegedly fell down while in a mall, with complete loss of consciousness for approximately 3 hours. He was brought back home in a state of poor responsiveness and nursed there with multiple bruises on his face, neck and upper limbs. Copious vomiting was noted once he came around, along with very scant dark black-coloured urine.
On the day of admission, he was alert, oriented, hypovolemic clinically, had complete amnesia of the event, BP 160/100 mmHg, PR 82 bpm regular, wt 68.2 kg, and ecchymoses of the limbs noted.
After an initial evaluation, he was found to significantly increased urea (180.4) and creatinine (10.5) levels. The patient was diagnosed with Oligo-anuric AKI (bulky bilateral kidneys on ultrasound) with hyperkalemic metabolic acidosis in the setting of rhabdomyolysis, following skeletal muscle injuries during the seizure. He had ageneralised seizure in the setting of substance abuse, accelerated hypertension, hypocalcemia, and hyponatremia. He had uremic vomiting and dehydration, leading to contraction metabolic alkalosis.
The patient was managed with aggressive intravenous fluid replacement, levetiracetam IV, correction of electrolyte imbalance, trial of IV loop diuretics without success, and initiation of hemodialysis via internal jugular access. CPK, AST and ALT levels improved daily. Psychiatry evaluation was done in view of multiple addictions. Nutritional counselling was provided. He made a good overall improvement before his discharge on day seven.
The patient received a total of 7 sessions of haemodialysis, before making a complete renal recovery. HD perm-cath was removed, and he has been stable with creatinine 0.8 mg/dl since then.
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