Q: My mother was 68 years old and had diabetes for more than 20 years. Her sugar tests were always under control and she was taking medicines for diabetes and high BP with a restricted diet. Her other tests including ECG were normal too. A month back she had swelling in her leg and was suffering from chest congestion. She was taken to our family doctor who measured her BP, which was high so he gave some BP and cold medicine. The swelling went off but the cold continued. A week later there she developed body swelling and the chest congestion was still there. We again took her to the doctor, as she could not also pass urine. The family doctor gave medicines for urine to start and suggested a heart related checkup as she had breathing problems. She took medicines and was taken for an ECG. Thereafter, she was admitted to a hospital as she was having a breathing problem. Entire medical tests were performed and the kidney function was normal. The albumin levels were within margin. She was put on oxygen and a catheter was injected. Her urine started coming to 1500 ml and she was shifted to a room from the ICU. Within a day or two, the urine stopped once again and the reports showed high creatinine and albumin levels. She was given medicines and again the urine started coming (but dialysis was not started). Late evening, suddenly, she stopped responding to medicines and 3:00 am at night, we were told that her heart is not functioning properly. The next day she had a heart attack and died. My query is that when the urine formation stopped - does it mean that the kidney failed? If yes then could dialysis have not helped? If not, why? Why did she develop a sudden heart problem? Was this incident due to some infection? If it was an infection, what was it - septicaemia or some other blood/urine infection? Why did her heart stop working?

A:My condolences for sudden and untimely demise of your mother. With the provided information, it is very likely that your beloved mother died of a sudden cardiac arrest. Since her illness was preceded by flu-like symptoms, it appears that she had a viral illness, which may or may not have culminated into a bacterial pneumonia. Certain viral infections may involve heart muscles leading to viral myocarditis resulting in congestive heart failure, arrhythmia, etc. and concurrently involve kidneys as well. Since her kidney function was reportedly normal in days preceding her sudden death it appears unlikely that dialysis would have altered her outcome in any way. Septicaemia may have been a plausible explanation but the fact that she was moved out of ICU possibly due to improvement in her overall condition speaks against it as a likely cause of her death. Similarly, in the absence of details about her blood tests and EKG rhythms it is difficult to comment on heart attack. Overall picture appears consistent with sudden cardiac arrest secondary to a life threatening condition.