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74 years old, had pneumonia. CT scan showed cerbral atrophy. Taking angizem cd. Why face swelling?

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My father is an indian, Doctor my father aged 74, had a pneuomonia( hospitalised and cured 2010), fell down in 2009 , CT SCAN REVEALED cerbral atrophy left side, ecg left axis deviation, Doctors treatment ASOMEX 0.5 mg at 8am, Prolommet 12.5 mg once daily, Enace 10,Doxolin 1/2-1/2-1/2, angizem cd 90 mg once daily at 8 am , Aztor 5 mg daily night and inhalers(Avessa & Combimist) 3 times daily. when he is using Enace D 10 ,Na is getting down and potasium is getting low, When he is using Enace 10 both legs down below knee are swelling, past 3 days face swelling also. Doctors treating him fearing to treat him treat with Enace D 10.

Urea 38, Na 120 K -2.5 , Hb 10.5 , Crarinine 1.7 , Slight albumin in Urine. Lipid Normal , Thyroid Normal.

My father test result is prior to switching over to medicine enace 10 inlieu of enace d10 15days back. Recent BP is 160/80 , one day back.
We have consulted with a cardiologist & General medicine doctor, they are suggesting to consult a nephrologist.
His past history is smoking, skin sometimes gets redish patches if presssed, leg muscles are weak. Can he use acibrium, his leg muscles are very weak without any support base. He has been suffering this sodium fluctuatio( 120 to 134) past 3 yrs, but 15 days back his potasium level was 2.5, so treating doctor immediately stop Enace D 10 and Switched over to Enace 10 that is causing swelling of legs and face. his Systolic is in the range of 140 to 170 but dialstolic always 80. pulse rate ok.

PL tell nephrologically what medicines to take, the present medicnes how to alter and kidney function keep normal. Please suggest medicines without diuretics.

Pl suggest what to do? Please suggest some medicines and alteration of medicines.
Posted Tue, 27 Nov 2012 in Kidney Conditions
Answered by Dr. Ravi Bansal 1 hour later

I understand your dilemma. The "D" in enace is a thiazide diuretic and is likely to cause low sodium and potassium.

If patient has swelling then sodium is bound to be low because of dilution hyponatremia. How to break this vicious cycle is by--

REDUCE water and all liquid intakes to less than 1 litre /day. (Including tea and coffee) – Very important.

Then you have to take diuretic to bring out more water. Use potassium sparing diuretics.- a combination or torsemide and aldactone in twice daily dosages.

Now if sodium and potassium levels fall. Replace with salt and potassium supplements.

keep a check on Na and K and Serum Creatinine twice per week.

I think your nephrologist will be able to guide you for this.

Do not worry this situation can be controlled.

You have asked for acibrium- kindly let me know the constituent chemicals in the tablet.

Hope this helps any further query please feel free to ask.

Above answer was peer-reviewed by
Follow-up: 74 years old, had pneumonia. CT scan showed cerbral atrophy. Taking angizem cd. Why face swelling? 4 hours later
Thank u dr

Our treating doctor is not very clear about Aldosterone antagonist

or torsemide and aldactone ( will it spare K & reduce Na) - what should be the doses( mg and timings). Bcause my father initial problem was with Na ( 120- 134) this is for the fist time K was 2.5 ( all other times K was within limit).

If you can explain this , so that treating doctor will be cleared.

So edema to reduce, BP to be under control & Na & K both should be with in limit. We are eagerly waiting for your reply.
Answered by Dr. Ravi Bansal 50 minutes later

Thanks again for following up.

1. Most important is fluid restriction as described earlier. The exact doses and frequency of medication can be decided by the treating nephrologist after examining the patient alone.

2. Torsemide and spironolactone come by different names. One among them is "torlactone" which can be started twice daily doses under supervision of doctor.

3. To replace salt, salt capsules which contain 5 gm salt can be used from 2/day to 6/day

4. To replace potassium, potklor syrup can be used as per patient needs.

In all the exact dosing and treatment prescription is best determined by the doctor examining and treating the patient. Please discuss with your doctor about these options.

Hope this answers your query. Let me know if you have any other concerns.

Above answer was peer-reviewed by
Follow-up: 74 years old, had pneumonia. CT scan showed cerbral atrophy. Taking angizem cd. Why face swelling? 21 hours later
How to control the urine albumin, how the kidney function can be brought back to normal in this case. any food restriction to be done?

How the body will compensate the water need? if it restricted to 1 litre/day?
Answered by Dr. Ravi Bansal 6 hours later
Urine albumin can be controlled by-- keeping BP as near normal as possible-- 130/80. Use of ACE-Inhibitor medicines which he is already using, and treating all infections. - avoid non-veg food.

Minimal water need is 400 to 600ml/day for body function. So if you reduce to 1litre per day no problem will occur. Secondly you should remember there is already extra water in the body (there is swelling). So don’t worry about getting dehydrated.
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Follow-up: 74 years old, had pneumonia. CT scan showed cerbral atrophy. Taking angizem cd. Why face swelling? 2 days later
Thank you Dr.

Our treating Dr. has gone thro your advise and he is of the same opinoin as u suugested. Only by reduction of Water intake to 1 litre in 2 days BP became 130/60
and little reduction of sweeling. So the trating doctor now has advised to take Dytor 10 mg ( 1-0-0) and to get Na. K & Creatinine to be tested after 15 days.
But the Doctor has stopped the Prolomet 12.5 mg.

He is very much impressed on you suggestion.

Pl . suugest further , is right move treating dr has taken. Will it reduce Na?
Answered by Dr. Ravi Bansal 7 hours later

It is nice to hear from you that he is better.

I think you should go by doctor’s advice.

If the swelling in the legs goes away, then we can stop Dytor. This may happen in 3 to 4 days. Please discuss with your treating doctor as the swelling goes away completely.

You may also do his blood tests after 7 days rather than 15 days.

Hope this helps.

Best of luck to you,
Above answer was peer-reviewed by
Follow-up: 74 years old, had pneumonia. CT scan showed cerbral atrophy. Taking angizem cd. Why face swelling? 7 days later
Thank u Dr for your kind advice and improvemnt of my father according to your advice.

My father was given Dytor 5 mg for 5 days and swelling got diminished totally.

so we stopped from 6 th day dytor and got his blood tested on 6th day

test result NA 132 , k 4.9, cL 102 , Cratinine 1.9 and ESR 72 1 hr.

HE is with Enace/ Asomex/ Angizem/ Doxolin and fliud restriction.
His current BP 140/80
Our question again if swelling comes then whether Dytor can be given or not if yes for how long?

in abesnce of dytor whether this combination will maintain the BP?

Creatininee high what to do-any medicine or bP control will do?

Instead of Dytor K sparing medicine will be better or not?

Any short antobiotic course for urine infection can be given as preventive measure?

Pl guide us?

HE is facing hiccuup problem along with some cough while taking food from 2 nd day of dytor 5 mg taking pl guide us.
Answered by Dr. Ravi Bansal 2 hours later

If swelling comes back again, you can restart dytor 5mg once a day or once in 2 days (alternate day). Only work of dytor is to remove swelling. If swelling is coming back again on stopping dytor you can even take it continuously for long time, but then we have to keep a watch on sodium and potassium. This is a prescription drug; please do take it under the guidance of the primary treating doctor.

The above treatment should be able to control BP (Blood Pressure) but fluctuations can occur and doses of medicines should be revised as per treating doctor.

Creatinine may remain in same range, periodic checkup for creatinine at least once a month to identify any reversible factors.

DO not use potassium-sparing agents.

No prophylactic treatment for UTI (urinary bladder, blood sugar control, and use cranberry juice extract tablets.

For hiccups, try Tab perinorm CD under guidance of your doctor.

Hope this helps.

Above answer was peer-reviewed by
Follow-up: 74 years old, had pneumonia. CT scan showed cerbral atrophy. Taking angizem cd. Why face swelling? 45 hours later
Thank u very much for improving my father’s condition.

Now Dr. if Dytor 5 mg he can’t tolerate for more than 5 days but had to stop,

then in the absence of Dytor 5 mg which medicines will take care of his BP.

Whether Dytor 2.5 mg can be given regularly to maintain BP<= 130/80 ?
Without edema and not affecting Na & K then when to stop Dytor

1)     Voimiting tendency is coming with Dytor while taking food and after food? How to control it?

2)     Creatinine 1.8 what to do? Isn’t on the higher side?

3)     ESR 1 hr 72 it is on the higher side – what may be the possible reasons and remedy?

Kindly advice.

Answered by Dr. Ravi Bansal 6 hours later
Dytor is NOT a BP medicine. It is only to improve swelling in the legs. so if there is no swelling do not use dytor. For control of blood pressure, there are other medicines, which your doctor can guide you.

Vomiting tendency is not feature of dytor.
See if blood pressure is low. Give a glass of lemon water only for once today.
You can use pantoprezole, ondensetron for vomiting and acidity under guidance of your doctor.

Serum creatinine is slightly high.
We have to see if there is chronic damage or any acute factors. Your doctor can judge this by patient examination and testing. If it is chronic, it will remain in this high range. You should not worry about the same. Be on regular check up. However, if it progresses rapidly, you need to be more careful.

High ESR can be a feature of anemia or hypergammaglobulinemia. This needs to be looked at by the doctor.

Hope this helps.
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