However, patient was shifted to a government hospital due to financial constraints where he expired after two days. Procurement of medical grade hydrochloric acid was attempted. CT scan revealed an acute subdural hemorrhage in the right parietal region. On the fourth day he developed further deterioration in level of consciousness and developed myoclonic jerks, tetany and seizures. Intravenous calcium gluconate (10 mg) followed by 1500mg calcium carbonate per day was administered for hypocalcemia (corrected serum calcium levels 7 gm/dl). Lower bicarbonate containing dialysate was unavailable. Haemodialysis with dialysate containing 25-28 meq/dl of bicarbonate was tried twice. Oral acetazolamide 250 mg per day was started and the frequency of the proton pump blocker was increased to twice a day. Inspite of improvement in presenting complains of fever, vomiting and diarrhoea, his renal function deteriorated progressively over the next two days (serum urea 90 mg/dl, creatinine 5.2 meq/dl). coli growth in urine) was treated with antibiotics according to sensivity reports. Milk based enteral nutrition (up to 2 litres per day) along with supplementation of magnesium, phosphate, vitamins and trace elements were started. Under careful monitoring, replacement of normal free fluid, potassium and sodium chloride was started.
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