A Case Quiz from Dr. Amarsinha Nikam

Recent Renal Failure

Can you solve this case?  Send your solution, including the rubrics you used, to:  [email protected]

This is a very interesting case of a 38 year old lady where the first dose was given to the patient when she was admitted in a super specialty hospital and was being prepared for the first dialysis!  She was detected to have recent renal failure with Creat. – 8.9 units and urea. 79.7 units.  On the 3rd day after giving the dose, the creatinine was found to have reduced by 2 units. She took AMA (against medical advice) discharge, leaving all the specialists in wonder about how can such small sweet sugar globules act so fast to do the miracle of lowering the creatinine without dialysis.  I got her admitted in my hospital for the next month and  discharged her when her creatinine level was within a relatively safer limit i.e. 5 units and urea level 102.2 units. (Note: Creatinine level is a better criteria for monitoring renal function as compared to urea!)        Since then, I repeated the dose only once…and her creatinine level still remains below 4 units.

C/C :

1. Breathlessness since 10 days.

< Lying.                                   > Sit.

< Talking.                                > Sit back with support.

< Ascend-descend.                   > Mouth breathing.

< Exertion.                     > Cold water drinking.

2. Dry cough since 10 days.

< Night – cannot sleep due to cough.              > Sitting propped up.

< Lying (Rt) side.

3. Hypertension, B.P. 200/140 mmHg since 3 months.

4. (Lt) foot injury with sepsis – taking ℞ for that purpose.

5. Backache < Exertion. > Lying down on abdomen, rubbing.

6. Sudden cramps in calves and ribs. Wandering pains. Sudden onset.

Has to stop while walking and rub vigorously.

< Lying down                                    > Occupied

< Turning sides suddenly                  > Rubbing

Past History :

1. Migraine alternate sides 2 years ago.

< Exertion mental.                   > Hard pressure.

< Evening.                               > Cold applications.

2. Sensitive to Penicillin and sulfa drugs.

Hypersensitivity causes deep burning eruptions on body.

3. Eruptions like red rash on the buttocks

< Hot humid climate.

< Rainy season.

< Wet clothes from

4. Allergy to mushrooms.

Family History :

• Father : Death due to M.I.
• Mother : Death due to HTN + DM 4 years ago.
• Sister : HTN
• Brother : HTN

Personal History :

• Appetite : ↓↓ eats less due to early satiety.
• Desire : Fish⁺⁺ / Salt⁺⁺/ Fried / MUD (Indigestible)/ Sweet⁺⁺ / Ice cream⁺⁺⁺ / Fruits⁺⁺
• Aversion : Bitter
• Food < : Mushroom – allergic rash
• Thirst : Thirsty for cold water
• Tongue : Dry and white coated
• Perspiration: Scanty but ++ on fear, offensive
• Stools : Normal
• Urine : ↓ quantity
• Sleep : Sleepless due to frightful thoughts + dreams
• Dreams : Screams due to fear, as if somebody attacking her.
• Thermal :  AMBITHERMAL

Sun < Skin rashes       > Open air

Cannot tolerate extremes but towards hot.

Mind

Accompanied by her sister, she was dressed to be a very jolly lady with a childish tinge and frequent tears during consultation.

1. How is your Nature ?

Oh! I am a very talkative girl. I like to do many things at a time but I start off with one and never complete it!

2. How was your childhood ?

It was very happy. Mom and father used to love us (1 sis. + 1 bro.) (patient is youngest). We used to have a good time. In childhood as compared to my sister, I was shy and timid. But after completing LLB, I become a bit courageous.

3. Did you start working as an advocate?

I did work for a year, but anyway I used to have some problem during the presentation and all would tease me. I got fed up one day and left the job. Now I give free advice to anybody who approaches me in some legal matter.

4. Why don’t you start working again?

Oh No! I would not do that again…I don’t like…

5. What about marriage ?

Sister : Sir, our mother died 4 years ago. We were all very depressed at that time. We had no time to think about the marriage because we had to earn our living. We were each other’s support in the battle of life.

6. Can you tell me when do you get disturbed ?

(Tears) My mother’s death! It was a very great shock for me. Had it not been for my brother and sister I would have collapsed! I would not dare to remain in a dark room due to fear of some dangerous soul present in the room. How could I remain alone in this big cruel world?

Response :

It took 15 days for the cough and breathlessness to disappear gradually but steadily. She started feeling strength and could sleep peacefully without any bad dreams. Her appetite improved drastically and I had to restrain her from over eating. I discharged her one month later and called her for a fortnightly follow up and urea creatinine test.  The latest report on 29.07.2006 shows urea 79 and creatinine 3.7 units. She shows no symptoms of uremia or body fluid collection at all.

Can you solve this case?  Send your solution, including the rubrics you used, to:  [email protected]

Editor’s Note:  Dr. Amarsinha Nikam is a renowned homeopath who runs the Aditya Homoeopathic Hospital and Healing Centre in Pune, where homeopathy is the only medicine used.