Diabetes Mellitus - Nephropathy/Acute on Chronic Kidney Failure

Current Health condition
Diabetes Mellitus - Nephropathy/Acute on Chronic Kidney Failure, Hypertension, Post Valvular Surgery/ Chronic Heart Faliure, Chronic Airway Hypersensitivity,UTI (Klebsiella)- Urosepsis;Septic/Congestive Hepetitis - Recovered
Parkinsonism Plus - Artherosclerotic related with Neuropsychiatric manifestation

Age 75 Years Female/ 59 Kgs

My Mother has been Hypertensive and Diabetic for 25 years.

She under went a sucessful knee replacement surgery in 2006 however the post operative care for her diabetes was mismanaged and following frequent episodes of Hypoglycemia, suffered frontal lobe damage ( MRI was done) - her symptoms were - lack of communication, blank staring eyes, difficulty in walking with feet pointing inwards while walking and incontinence - She was treated by a neurologist with medicines Nicerbium 30mg,Donecept5mg and Arantrel 100mg, she improved considerably after a year she was sociable, though her movement was slow, her feet tended to point inwards and she was aware of her incontinance.

In 2006 she was diagnosed with calcified Aortic valve stenosis - Symptoms were breathlessness and light headedness. She was having Homeopathy medicines ( Unable to give the name of the medicine ) for the same, while the breathlessness imroved for a while, it returned with severity end 2008 and had to undergo an emergency Aortic valve replacement on 16/1/2009.
Her Post OP investigations were as follows
HB%- 10.0 g/dl
Blood sugar Fasting -262mg/dl
Blood urea - 262 mg/dl
Creatinine - 0.9 mg.dl
Sodium - 133 mEq/L
Potassium - 4.1 mEq/L
Total bilirubin 0.9 mg/dl

Back at home she was getting very breathless and on the 7th day review showed Anemia with heamoglobon count of 8.5%

She was addmitted and 2 units of packed cells were given and the diagnosis was
Statupost Aortic valve replacement
Mild Coronary Artery Disease
Hypertension
Diabetes Mellitus
Chronic Kidney Disease
Anemia
Hyperuricemia

at the time of discharge her lab investigations were as follows
HB%- 11.0 g/dl
Blood urea - 32.0 mg/dl
Creatinine - 1.1mg.dl
Sodium - 135 mEq/L
Potassium - 4.0 mEq/L

However her breathlessness continued to get bad and Nebulising with Budecort and Duolin showed no improvement, any exertion worsened the breathing and she was gasping for air.

A lab test was redone and showed the following results
HB%- 9.0 g/dl
Blood sugar Fasting -159mg/dl
Blood urea - 36 mgs/dl
Creatinine - 1.7 mg.dl
Sodium - 134 mEq/L
Potassium - 4.9 mEq/L
we were asked to return to the hospital and while transporting her into the car she turned blue around the lips, her eyes were blank and breath became extrmely shallow and she was clammy. She had to be transported by ambulance and had stabilised by herself before we reached the hospital.
The following was the diagnosis

Diabetes Mellitus - Nephropathy/Acute on Chronic Kidney Failure, Hypertension, Post Valvular Surgery/ Chronic Heart Faliure, Chronic Airway Hypersensitivity,UTI (Klebsiella)- Urosepsis;Septic/Congestive Hepetitis - Recovered
Parkinsonism Plus - Artherosclerotic related with Neuropsychiatric manifestation

She had severe fluid retention in the body, she was in the ICU for 6 days and 4days in the room before discharge.

While in the hospital, she was extremly angry, she refused to eat and when forced to eat showed anger and was abusive. Extremely weak unable to Prop herself up into sitting position or even stand. She developed bedsores which were taken care of with the help of a water bed, severe rash on the inner thighs closer to the Vagina which continues to be sore due to constant use of diapers and pads.Her creatinine levels were fluctuating and lasix injections were given intravenously. In the hospital her urine output was satisfactory and on discharge the lab tests were as follows

Blood Glucose Random-157mg/dl
Blood urea - 89 mgs/dl
Creatinine - 1.2 mg.dl
Sodium - 134 mEq/L
Potassium - 3.7 mEq/L
She was advised fluid restriction of 800ml/day nil salt veg. diet.

On returning home her breathing is absolutely normal,however she has no appitite, extremely angry / upset and abusive, cries out in pain when we try to lift her move her legs, talks of wanting to die, general weakness, no control on bladder or on motion. Passes motion 3 to 4 times a day - the stool is yellow soft and has some mucus in it - foul smelling. Her Urine output in 24 hours is only once and we are not able to guage the amount - compared to the output in the hospital it seems negligible.Feels cold, refuses to have the fan on, the temperatures now in our city is 32degrees.Her medications are as follows

T lasix 40 mg 1-1-0
T Lanoxin .25mg 1/2-0-0
T Aldactone 25mg 1-0-0
T Zyloric 100mg 1-0-0
T Sodabicarb 2-2-2
T Imdur 0-1-0
TCardarone 200mg 0-0-1
T Clopilet 75mg 0-1-0
T Nicerbium 30mg 1-0-1
T Dopezil 5mg 0-1-0
T Pantocid 1-0-1
T Montair10mg 0-1-0 T Becosyme c forte 0-1-0
Inj. H. Actrapid 6U- 6U - 4U
T Septran 0-0-1 for 1 week
T Nitcol 500mg 1-0-1 3 days
T cefran 250 mg 0-0-1 5 days

Her lab result as of 9/3/2009 is as follows
Heamatology
Total WBC - 8,600/cmm
Haemoglobin 10.2 gm%

Biochemistry
Glucose - Fasting 153 mg/dl
Blood Urea Nitrogen -35.6mg/dl
Creatinine 1.8 mg/dl
Uric Acid 10.8mg/dl

Enzymes
SGOT (AST) 33U/L
SGPT (ALT) 30U/L

Electrolytes

Sodium 133 mmol/l
Potassium 4.20 mmol/l
Chloride 95 mmol/l
Bicarbonate 29 mmol/l

We are looking for help with the Kidney function, increased urine output, mental health and appitite

We would be extremely grateful if you could help us.

Thanking you in advance,
Nandini