Congestive Cardiac Failure with Pre-renal Acute Renal Failure

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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:

Triage: Category II

Generalized anasarca, obsese;

P- 110/min, irregular

BP- 130/90

RS – Harsh rales and ronchi

JVP – increased

CVS – Gallop Rhythm

CNS – Unconscious, not responding to commands, movement of LL to pain stimuli; Planters – NAD.

PA: Liver 3 FP

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:

  • Poor urine output
  • Genralised Anasarca
  • Pulmonary edema
  • Wheezing in the chest
  • Tachycardia with irregular pulse

Repertorial Totality from Complete Repertory:

  • Kidneys; SUPPRESSION of urine, anuria (p, 156, 27-77)
  • Generalities; SWELLING; General; edematous, dropsical; heart complaints, in (m, 53, 2-2)
  • Respiration; WHEEZING (p, 165, 24-47)
  • Heart & Circulation; PULSE; Rapid, tachycardia; intermittent, and (p, 48, 2-2)
  • Chest; EDEMA of lungs (p, 49, 3-6)

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:

  • IV fluids
  • Chest physiotherapy
  • Ryle’s tube
  • Urinary catheter
  • Oxygen

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.

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Dr. Leela D’Souza, MD (Hom)

www.homeopathy2health.com

About the author

Leela D'Souza

Leela D'Souza

Leela D'Souza-Francisco, MD (Hom), CIH (Cardiology) is a Mumbai-based homeopathic professional whose experience includes intensive graduate medical training at India's leading homeopathic medical institution in Mumbai, completed in 1990. She completed her MD (Hom) from MUHS, Nashik in 2008 with a Dissertation entitled "Emergency Management in Homeopathy". She obtained a post graduate MSc (Homeopathy) degree from UCLAN, UK in 2009 with a Dissertation entitled "How Can We Develop Suitable Clinical Trials for Research in Classical Homeopathy". Her present interests include management of in-patients in homeopathic hospitals, and clinical research in classical homeopathy. She has been in practice for over 20 years and is online at www.homeopathy2health.com for the last 15 years. Presently she is Consulting Homeopathic Physician, with specialization in Cardiology at Holy Family Hospital, Bandra, Mumbai.
Visit Dr. Leela D'Souza at her website : http://www.homeopathy2health.com/member.htm
and contact her at: [email protected]

1 Comment

  • Again it is confirmed that homeopathy is great science.homeopathy also works in critical cases…..
    Thanks

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