Case of COVID with Old age, Obesity and Chronic Kidney Disease

A sixty years old obese gentleman was admitted with complains of fever and weakness since last five days. He had diabetes and chronic kidney disease since last six years. He was suspected having COVID 19. For further management in view of multiple comorbidities, he was shifted to Ahmedabad under my care. He was stable initially. His COVID RT PCR test was positive for SARS COV 2 virus with heavy viral load. Many of this patients remain stable for initial few days and deteriorate rapidly thereafter. On third day morning he was well however in the evening rounds I found him breathing fast though he was comfortable and unaware of it. There was slight downward trend in his oxygen saturation level. This was an alarming situation as there was high risk of rapid deterioration in oxygen level in is blood (PO2). With the experience of treating hundreds of patients in last few months, I could clearly see the danger on the horizon. I asked for his blood gas analysis to look at actual presence of oxygen in his blood and ordered to shift him to ICU though present condition did not appear so alarming. His blood gas analysis suggested significant reduction in his blood oxygen levels. He was given special mask with higher flow of oxygen. Just within next few hours his condition deteriorated. His blood tests were suggestive of cytokine storm. He was on Injectable Remdesivir, the only medicine to kill the virus was going since the day of admission. However he deteriorated early morning and he needed non-invasive ventilator support to breath. His condition remained critical for next one week in spite of all supports. Minimal movement or activities like eating caused significant reduction of his oxygen levels to 82% from 95%. However with rigorous intensive care his oxygen levels improved. Now with BIPAP ventilator support he was breathing comfortably. He needed ventilator care for a long period of around eleven days. Thereafter he could be successfully weaned from ventilator support. His cytokine storm got controlled and he was now able to take soft diet with minimal fluctuations in oxygen levels. His condition kept improving for next few days and he was transferred to ward. He kept improving in ward. After almost a month of stay at hospital was discharged.