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| Hpathy Ezine - July, 2009 | ||||
Congestive Cardiac Failure with Pre-renal Acute Renal Failure-- Dr. Leela D'Souza |
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| Preliminary Data: Female, 85 yrs, widow, Higher middle class, Parsi Acute History: The patient was admitted for fracture of neck of right femur and a joint replacement was done in a General Hospital in August 1992. Unfortunately the prosthesis developed infection and this resulted in septicemia. When the infection was brought under control, she was taken up for surgery and prosthesis was removed. The case was under the care of an MD physician in the ICU for a few weeks till the patient was finally transferred to a room with a private nurse, who maintained all the charting and medication with regular intensive care observation. When I saw the patient, she was unconscious, with generalized anasarca, breathing very harshly. She was on Ryle’s tube feeds. An input output chart was being maintained. Urine output was < 250-300 ml per day, while input was maintained at 1500 ml/day. The output was forced with regular Inj. Lasix through the IV. The poor renal function was due to decompensated cardiac output of CCF and sequelae to septicaemia. The wheezing in the chest was cause primarily by pulmonary edema due to heart failure, though there may have been a secondary respiratory component. The pulse was irregular and she had tachycardia.
Examination:
Investigations: Unrecorded as Hospital records older than 10 years have been destroyed. During that time, continuous monitoring of electrolyte levels, blood sugar, blood count, renal function, cardiac function, etc was maintained by the MD physician following up her case. Diagnosis: CCF with prerenal Renal Failure and generalized Anasarca.
Emergency totality and analysis: Here is a case already on allopathic drugs with symptomatic treatment that was now not having much effect. Repeated IV injection lasix was producing hardly 200cc of urine over 24 hours. This suggested suppressed urination consequent to poor cardiac output. The following symptoms were considered for the totality:
Repertorial Totality from Complete Repertory:
The remedies are Digitalis, Ars Alb and Lachesis. Here the pathology was poor cardiac function and consequently poor renal function. Digitalis is the remedy that has this sphere of action and hence it was chosen at this point of the case. The potency chosen was 30C with the idea that this was low potency working at the organ level. The frequency given was three times a day. Ancillary measures:
Plan of Emergency Management and Follow Up: The aim of homeopathic management in this case is to restore vital organ function to the point that the patient becomes adequately self sufficient and not dependant on intensive care support. Obviously cure is not an expectation and hence the chronic history was not considered at this stage. 24 hours: Anasarca 50% better; Urine output 600 cc in 24 hours 48 hours: Chest wheeze better, liver 2 FP; Urine output 1000cc; Anasarca disappeared, only edema on dependant areas (buttocks, ankles) + IV Lasix stopped, IV deriphyllin reduced 72 hours: Patient regains consciousness and is responding to oral commands. Now has developed sudden episodes of fear; clinging to the sides of the railing of her bed with fearful look in her eyes. Digitalis 30 od Gelsemium 30 bd After 10 days: Patient conscious, sitting up to eat, Ryles tube removed, no anasarca, chest clear, no pitting edema, Urine output normal, cardiac function good. Patient was discharged to be looked after at home by nurse in
a hemodynamically stable condition, with the functioning of vital
organs stable. She remained on a wheel chair as she was unable to
bear weight on the Rt. Leg without the hip joint prosthesis. Discussion DC17: This was a case seen very early in my practice, while I was Resident Medical Officer at a general hospital. This patient was already admitted for over a month in the hospital and ICU with one complication after another. No deep analysis was done in terms of miasm or classification of disease. The case was being managed with symptomatic allopathic treatment, with poor prognosis and they were simply awaiting her death following all systems shut down. Homeopathic intervention here allowed her to stabilize in the vital organs to the point where she even regained consciousness though without intact higher function and could not communicate in conversation. Her son was able to take her home with a mounting hospital bill that reduced within 10 days of homeopathic medication being started. Due to her symptomatic improvement, the allopathic drugs were also drastically reduced and she went home on a very small prescription as maintenance dose. ------------------------------------------------ Dr. Leela D'Souza, MD (Hom) |
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