Diabetes, fluid retention, ultrasound showed splenomegaly. What to do?
Patient: SIR WE HAVE DONE FOLLOWING TESTS (CASE HISTORY) PATIENT NAME-PREMALATA BISWAL,AGE -76 YRS,(FEMALE)HAVING LONG STANDING DIEBETIC TYPE-2,COMPLAINED ABT ASCITIC FLUID RETENTION.1ST WE DID U S OF ABDOMEN & PELVIS .RESULT OR IMPRESSION:CHRONIC MEDICAL RENAL DISEASE GRADE -III,MILD SPLENOMEGALY ,MILD TO MODERATE ASCITES ,THEN WE DID FLUID EXAMINATION-FLUID EXAMINATION(22.09.2012) : SPECIMEN-ASCITIC FLUID,COLOR-PALW YELLOW,VOLUME-08 ML,CLOT-NIL,SUGAR(GLUCOSE)-1588 MG/DL,PROTEIN-1.2MG/DL, ADENOSINE DEAMINASE ACTIVITY-08 U/L,GRAM STAIN-NO BACTERIA SEEN,Z.N STAIN OF AFB-NEGATIVE,CYTOLOGY TOTAL COUNT-225 CELLS/CUMM,DIFFERENTIAL COUNT:CYTOSMEAR FROM CENTRIFUGED DEPOSITS SHOWS: LYMPHOCYTES-70%,MESOTHELIAL CELL-25%,POLYMORPHS-5%,NO MALIGNANT CELL SEEN.AFTER WE DID CA 125,RESULTS 42.00 U/ML,CA-19.9 RESULTS-126.91 U/ML,AFTER THIS WE PERFORMED PLAIN & CONTRAST(BOTH ORAL & IV)ENHANCED CT SCAN OF WHOLE (29.09.2012)ABDOMEN,IMPRESSION:FEATURES ARE SUGGESTIVE OF 1)MODERATE ASCITES,2)MILD THICKENED ANTERO-PYELORIC WALL OF STOMACH,3)RIGHT RENAL CYST.4)MINIMAL RIGHT SIDE PLEURAL EFFUSION.SUGGESTED :UPPER GI ENDOSCOPY.AFTER THIS WE DID ENDOSCOPY ON 30.09.12 IMPRESSION- FEATURES OF GASTRO-DUODENITIS.KINDLY SUGGEST WHAT TO DO? Doctor: Her ultrasound findings are suggestive of chronic kidney disease (CKD) however there are many tests which are needed to confirm it.1) Hemoglobin and CBC2) Kidney Function Tests3) Urine routine and 24 hours urinary proteins4) HbA1c levels5) ECG6) EchocardilographyAlso the sugar levels in ascitic fluid are very high indicating that her diabetes is uncontrolled.Accumulation of fluid in abdomen can be a part of diabetic kidney disease as well as of associated heart disease.All these reports are required to know that.Meanwhile, she shouls reduce her sugar, salt and water intake and take medicines like Lasix or Dytor if not taking already.Should get in touch of a nephrologist in your city.