from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.oxml.ns import qn
from docx.oxml import OxmlElement
import datetime

doc = Document()

# ── Page margins ──────────────────────────────────────────
from docx.shared import Cm
section = doc.sections[0]
section.top_margin    = Cm(1.8)
section.bottom_margin = Cm(1.8)
section.left_margin   = Cm(2.0)
section.right_margin  = Cm(2.0)

# ── Default styles ────────────────────────────────────────
normal = doc.styles["Normal"]
normal.font.name = "Arial"
normal.font.size = Pt(10)

def set_heading(para, text, level=1):
    para.clear()
    run = para.add_run(text)
    run.font.bold = True
    run.font.name = "Arial"
    if level == 1:
        run.font.size = Pt(13)
        run.font.color.rgb = RGBColor(0x1F, 0x49, 0x7D)
    elif level == 2:
        run.font.size = Pt(11)
        run.font.color.rgb = RGBColor(0x2E, 0x74, 0xB5)
    else:
        run.font.size = Pt(10)
        run.font.color.rgb = RGBColor(0x37, 0x37, 0x37)
    para.paragraph_format.space_before = Pt(8)
    para.paragraph_format.space_after  = Pt(3)

def shaded_heading(doc, text, r=0x1F, g=0x49, b=0x7D):
    """Full-width shaded heading row (used as section dividers)."""
    para = doc.add_paragraph()
    para.paragraph_format.space_before = Pt(6)
    para.paragraph_format.space_after  = Pt(2)
    pPr = para._p.get_or_add_pPr()
    shd = OxmlElement("w:shd")
    shd.set(qn("w:val"),   "clear")
    shd.set(qn("w:color"), "auto")
    shd.set(qn("w:fill"),  f"{r:02X}{g:02X}{b:02X}")
    pPr.append(shd)
    run = para.add_run(f"  {text}")
    run.font.name  = "Arial"
    run.font.size  = Pt(11)
    run.font.bold  = True
    run.font.color.rgb = RGBColor(0xFF, 0xFF, 0xFF)
    return para

def add_table(doc, headers, rows, col_widths=None):
    t = doc.add_table(rows=1+len(rows), cols=len(headers))
    t.style = "Table Grid"
    # header row
    hdr = t.rows[0]
    for i, h in enumerate(headers):
        c = hdr.cells[i]
        c.text = h
        for para in c.paragraphs:
            for run in para.runs:
                run.font.bold = True
                run.font.size = Pt(9)
                run.font.name = "Arial"
        # shading
        tcPr = c._tc.get_or_add_tcPr()
        shd = OxmlElement("w:shd")
        shd.set(qn("w:val"),   "clear")
        shd.set(qn("w:color"), "auto")
        shd.set(qn("w:fill"),  "2E74B5")
        tcPr.append(shd)
        for para in c.paragraphs:
            for run in para.runs:
                run.font.color.rgb = RGBColor(0xFF,0xFF,0xFF)
    # data rows
    for ri, row_data in enumerate(rows):
        row = t.rows[ri+1]
        for ci, cell_text in enumerate(row_data):
            c = row.cells[ci]
            c.text = cell_text
            for para in c.paragraphs:
                for run in para.runs:
                    run.font.size = Pt(9)
                    run.font.name = "Arial"
            if ri % 2 == 1:
                tcPr = c._tc.get_or_add_tcPr()
                shd = OxmlElement("w:shd")
                shd.set(qn("w:val"),   "clear")
                shd.set(qn("w:color"), "auto")
                shd.set(qn("w:fill"),  "EAF0F8")
                tcPr.append(shd)
    if col_widths:
        for ri2, row in enumerate(t.rows):
            for ci2, cell in enumerate(row.cells):
                if ci2 < len(col_widths):
                    cell.width = Inches(col_widths[ci2])
    doc.add_paragraph()
    return t

def bullet(doc, text, level=0):
    p = doc.add_paragraph(style="List Bullet")
    p.paragraph_format.left_indent = Inches(0.25 * (level+1))
    p.paragraph_format.space_after = Pt(1)
    run = p.add_run(text)
    run.font.size = Pt(9.5)
    run.font.name = "Arial"
    return p

def kv(doc, label, value):
    p = doc.add_paragraph()
    p.paragraph_format.space_after = Pt(1)
    r1 = p.add_run(f"{label}: ")
    r1.font.bold = True
    r1.font.size = Pt(9.5)
    r1.font.name = "Arial"
    r2 = p.add_run(value)
    r2.font.size = Pt(9.5)
    r2.font.name = "Arial"

def small_para(doc, text):
    p = doc.add_paragraph(text)
    p.paragraph_format.space_after = Pt(2)
    for run in p.runs:
        run.font.size = Pt(9.5)
        run.font.name = "Arial"
    return p

# ═══════════════════════════════════════════════════════════
# HEADER BLOCK
# ═══════════════════════════════════════════════════════════
title = doc.add_paragraph()
title.alignment = WD_ALIGN_PARAGRAPH.CENTER
tr = title.add_run("INTENSIVE CARE UNIT PATIENT FILE")
tr.font.name  = "Arial"
tr.font.size  = Pt(16)
tr.font.bold  = True
tr.font.color.rgb = RGBColor(0x1F, 0x49, 0x7D)

sub = doc.add_paragraph()
sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
sr = sub.add_run("Acute Kidney Injury with Hypertension")
sr.font.name  = "Arial"
sr.font.size  = Pt(13)
sr.font.bold  = True
sr.font.color.rgb = RGBColor(0x2E, 0x74, 0xB5)

doc.add_paragraph()

# ── Horizontal rule ───────────────────────────────────────
def add_hr(doc):
    p = doc.add_paragraph()
    pPr = p._p.get_or_add_pPr()
    pBdr = OxmlElement("w:pBdr")
    bottom = OxmlElement("w:bottom")
    bottom.set(qn("w:val"), "single")
    bottom.set(qn("w:sz"), "6")
    bottom.set(qn("w:space"), "1")
    bottom.set(qn("w:color"), "2E74B5")
    pBdr.append(bottom)
    pPr.append(pBdr)
    p.paragraph_format.space_after = Pt(4)

add_hr(doc)

# ═══════════════════════════════════════════════════════════
# SECTION 1 – PATIENT DEMOGRAPHICS
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 1 – PATIENT DEMOGRAPHICS & ADMISSION DETAILS")
add_table(doc,
    headers=["Field", "Details"],
    rows=[
        ["Patient Name",            "___________________________"],
        ["Age / Sex / Weight",       "_____ yrs  /  M / F  /  _____ kg"],
        ["MRN / Hospital ID",        "___________________________"],
        ["Date of Admission",        "___________________________"],
        ["Admitting Unit",           "ICU / Medical ICU / Nephrology ICU"],
        ["Admitting Physician",      "___________________________"],
        ["Primary Diagnosis",        "Acute Kidney Injury (AKI) + Hypertension"],
        ["ICD-10 Codes",             "N17.9 (AKI, unspecified)  |  I10 (Hypertension)"],
        ["Source of Admission",      "Emergency Dept / Ward / OPD / Transfer"],
        ["Code Status",              "Full Code  /  DNR  /  DNI"],
    ],
    col_widths=[2.2, 4.2]
)

# ═══════════════════════════════════════════════════════════
# SECTION 2 – HISTORY & BACKGROUND
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 2 – CLINICAL HISTORY")

p = doc.add_paragraph()
set_heading(p, "Chief Complaint", level=2)
small_para(doc, "Oliguria / anuria  |  Rising creatinine / BUN  |  Hypertensive emergency  |  Fluid overload  |  Uremic symptoms")

p = doc.add_paragraph()
set_heading(p, "History of Present Illness", level=2)
small_para(doc, "Onset, duration, precipitating factors (e.g., sepsis, nephrotoxins, contrast, NSAID use, dehydration, volume depletion), prior CKD history, baseline creatinine.")

p = doc.add_paragraph()
set_heading(p, "Past Medical History", level=2)
for item in ["Chronic Kidney Disease (stage: _____)", "Hypertension – duration: _____ years",
             "Diabetes Mellitus", "Heart failure / Ischemic heart disease",
             "Renovascular disease / Renal artery stenosis", "Collagen vascular disease (SLE, Scleroderma)",
             "Recent surgery / trauma / contrast exposure"]:
    bullet(doc, item)

p = doc.add_paragraph()
set_heading(p, "Current Medications", level=2)
small_para(doc, "List all medications especially ACE-I, ARBs, NSAIDs, diuretics, aminoglycosides, vancomycin, contrast agents, immunosuppressants.")

p = doc.add_paragraph()
set_heading(p, "Allergies", level=2)
small_para(doc, "_______________________________________________________")

# ═══════════════════════════════════════════════════════════
# SECTION 3 – VITAL SIGNS & MONITORING
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 3 – VITAL SIGNS & HEMODYNAMIC MONITORING")
add_table(doc,
    headers=["Parameter", "On Admission", "Target/Goal", "6h", "12h", "24h"],
    rows=[
        ["BP (mmHg)",              "",  "SBP 140-160 (acute)", "", "", ""],
        ["MAP (mmHg)",             "",  "≥65 mmHg",           "", "", ""],
        ["Heart Rate (bpm)",       "",  "60-100",              "", "", ""],
        ["Temperature (°C)",       "",  "36.5-37.5",           "", "", ""],
        ["SpO2 (%)",               "",  "≥94%",                "", "", ""],
        ["Respiratory Rate",       "",  "12-20/min",           "", "", ""],
        ["GCS",                    "",  "15",                  "", "", ""],
        ["Urine Output (mL/hr)",   "",  "≥0.5 mL/kg/hr",      "", "", ""],
        ["CVP (mmHg)",             "",  "8-12 mmHg",           "", "", ""],
    ],
    col_widths=[1.8, 1.0, 1.4, 0.8, 0.8, 0.8]
)

# ═══════════════════════════════════════════════════════════
# SECTION 4 – AKI STAGING (KDIGO 2012)
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 4 – AKI STAGING (KDIGO 2012)")

p = doc.add_paragraph()
set_heading(p, "KDIGO AKI Definition (any ONE criterion):", level=2)
for crit in [
    "Serum creatinine increase ≥0.3 mg/dL (≥26.5 µmol/L) within 48 hours",
    "Serum creatinine increase to ≥1.5× baseline within 7 days",
    "Urine output <0.5 mL/kg/hr for ≥6 consecutive hours"
]:
    bullet(doc, crit)

add_table(doc,
    headers=["Stage", "Serum Creatinine Criteria", "Urine Output Criteria"],
    rows=[
        ["1", "1.5–1.9× baseline  OR  rise ≥0.3 mg/dL (48 h)", "<0.5 mL/kg/hr for 6–12 h"],
        ["2", "2.0–2.9× baseline",                              "<0.5 mL/kg/hr for ≥12 h"],
        ["3", "≥3.0× baseline  OR  sCr ≥4 mg/dL  OR  RRT initiated", "<0.3 mL/kg/hr for ≥24 h  OR  anuria ≥12 h"],
    ],
    col_widths=[0.6, 3.5, 2.5]
)

kv(doc, "Current AKI Stage", "Stage ___  (Circle: 1 / 2 / 3)")
kv(doc, "Baseline Creatinine", "_____ mg/dL")
kv(doc, "Admission Creatinine", "_____ mg/dL")
kv(doc, "AKI Category", "Pre-renal  /  Intrinsic (ATN / GN / Interstitial)  /  Post-renal")

# ═══════════════════════════════════════════════════════════
# SECTION 5 – HYPERTENSION ASSESSMENT
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 5 – HYPERTENSION ASSESSMENT")

p = doc.add_paragraph()
set_heading(p, "Classification", level=2)
add_table(doc,
    headers=["Class", "SBP (mmHg)", "DBP (mmHg)", "Action Required"],
    rows=[
        ["Hypertensive Urgency",   ">180",  ">120", "Oral agents; reduce over 24-48 h; no end-organ damage"],
        ["Hypertensive Emergency", ">180",  ">120", "IV agents; reduce MAP by ≤25% in first hour; end-organ damage present"],
        ["Malignant Hypertension", ">>180", ">>120","Papilledema ± retinal hemorrhages; treat as emergency"],
    ],
    col_widths=[2.0, 1.2, 1.2, 2.9]
)

p = doc.add_paragraph()
set_heading(p, "Current Classification", level=2)
kv(doc, "Admission BP", "_____ / _____ mmHg")
kv(doc, "Classified As", "Urgency  /  Emergency  /  Malignant  (circle one)")

p = doc.add_paragraph()
set_heading(p, "End-Organ Damage Assessment", level=2)
for organ in [
    "Renal: sCr elevation, proteinuria, hematuria (current AKI)",
    "Cardiac: ECG – LVH, ischemia / Echo – EF, diastolic dysfunction",
    "Neurologic: encephalopathy, focal deficits, fundoscopy",
    "Ophthalmologic: papilledema, hemorrhages, exudates",
    "Vascular: aortic dissection excluded"
]:
    bullet(doc, organ)

# ═══════════════════════════════════════════════════════════
# SECTION 6 – INVESTIGATIONS
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 6 – INVESTIGATIONS")

p = doc.add_paragraph()
set_heading(p, "Baseline Labs (on admission)", level=2)
add_table(doc,
    headers=["Test", "Result", "Normal Range", "Repeat Interval"],
    rows=[
        ["Serum Creatinine (mg/dL)",    "", "0.6–1.2",     "Q6–8 h"],
        ["BUN (mg/dL)",                 "", "7–20",        "Q12 h"],
        ["eGFR (mL/min/1.73m²)",        "", ">60",         "Daily"],
        ["Serum Potassium (mEq/L)",     "", "3.5–5.0",     "Q6 h"],
        ["Serum Sodium (mEq/L)",        "", "135–145",     "Q12 h"],
        ["Serum Bicarbonate (mEq/L)",   "", "22–29",       "Q12 h"],
        ["Chloride (mEq/L)",            "", "98–106",      "Daily"],
        ["Calcium / Phosphorus",        "", "8.5–10.5 / 2.5–4.5", "Daily"],
        ["Serum Uric Acid",             "", "2.4–6.0",     "On admission"],
        ["CBC with differential",       "", "—",           "Daily"],
        ["CRP / Procalcitonin",         "", "—",           "Daily if sepsis"],
        ["Blood cultures",              "", "—",           "× 2 sets on admission"],
        ["Urine output (mL/hr)",        "", "≥0.5 mL/kg/hr","Continuous"],
        ["Urinalysis + microscopy",     "", "—",           "On admission"],
        ["Urine Na / Cr (spot)",        "", "—",           "On admission"],
        ["FENa (%)",                    "", "<1% = prerenal", "On admission"],
        ["FEUrea (%)",                  "", "<35% = prerenal","If on diuretics"],
        ["24-h urine protein",          "", "<150 mg/day", "On admission"],
        ["Urine β2-microglobulin / NGAL","","—",           "If available"],
        ["ABG / VBG",                   "", "pH 7.35–7.45","Q6 h if acidosis"],
        ["PT / INR / aPTT",             "", "—",           "Daily"],
        ["LDH / Haptoglobin (TMA?)",    "", "—",           "If TMA suspected"],
        ["ANA, ANCA, Anti-GBM, C3/C4", "", "—",           "If GN suspected"],
        ["Chest X-ray",                 "", "—",           "On admission; repeat PRN"],
        ["ECG",                         "", "—",           "On admission; daily"],
        ["Renal Ultrasound",            "", "—",           "On admission"],
        ["Echocardiogram",              "", "—",           "If cardiac emergency"],
    ],
    col_widths=[2.5, 1.0, 1.6, 1.2]
)

# ═══════════════════════════════════════════════════════════
# SECTION 7 – MANAGEMENT PLAN
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 7 – MANAGEMENT PLAN")

# ── 7a Fluid
p = doc.add_paragraph()
set_heading(p, "7A. Fluid Management", level=2)
for b in [
    "Assess volume status: JVP, CVP, lung auscultation, weight, skin turgor",
    "Pre-renal AKI: Cautious IV fluid resuscitation – isotonic crystalloid (0.9% NaCl or Lactated Ringer's)",
    "Target MAP ≥65 mmHg to maintain renal perfusion",
    "Avoid fluid overload – daily weights, strict I&O, reassess Q4-6 h",
    "Avoid colloids (albumin only if severe hypoalbuminemia + intravascular depletion)",
    "Volume-overloaded AKI + HTN: restrict fluids; consider loop diuretics if urine output present",
    "Furosemide: 40–80 mg IV bolus; may titrate up to 200 mg IV if oliguric"
]:
    bullet(doc, b)

# ── 7b Antihypertensives
p = doc.add_paragraph()
set_heading(p, "7B. Antihypertensive Therapy (AKI-specific)", level=2)

small_para(doc, "Goal: Reduce MAP by ≤25% in first hour (hypertensive emergency). Avoid abrupt BP reduction (risk of AKI worsening from ischemia).")
add_table(doc,
    headers=["Drug", "Dose / Route", "Renal Use Notes", "Avoid If"],
    rows=[
        ["Nicardipine (CCB)",  "5–15 mg/hr IV infusion",       "First choice – maintains renal blood flow",        "Severe aortic stenosis"],
        ["Labetalol (α+β)",   "20–80 mg IV bolus Q10 min;\nor 2 mg/min infusion",  "Safe in renal disease",     "Asthma, acute decompensated HF, bradycardia"],
        ["Fenoldopam",        "0.1–0.3 µg/kg/min IV",          "Dopamine-1 agonist – increases renal blood flow; preferred in AKI + HTN emergency", "Glaucoma"],
        ["Clevidipine (CCB)", "1–21 mg/hr IV",                 "Short-acting; titratable",                        "Allergy to soybean/egg"],
        ["Hydralazine",       "10–20 mg IV Q4–6 h",            "Second-line",                                     "Avoid as monotherapy in emergencies"],
        ["Esmolol",           "500 µg/kg bolus then 50–300 µg/kg/min", "Only if tachycardia-driven",             "Asthma, severe bradycardia"],
        ["Sodium Nitroprusside", "0.3–10 µg/kg/min IV",        "AVOID in AKI – risk of cyanide/thiocyanate accumulation", "AKI (relative)"],
    ],
    col_widths=[1.6, 1.9, 2.2, 1.5]
)

small_para(doc, "NOTE: ACE inhibitors and ARBs are generally avoided in acute hypertensive emergency with AKI (bilateral RAS risk, hyperkalemia, worsening GFR). May be reintroduced cautiously at discharge after renal recovery.")

# ── 7c Electrolytes
p = doc.add_paragraph()
set_heading(p, "7C. Electrolyte & Metabolic Management", level=2)
add_table(doc,
    headers=["Problem", "Treatment"],
    rows=[
        ["Hyperkalemia K+ >5.5", "Calcium gluconate 10% 10 mL IV (cardiac protection)\nSodium bicarbonate 8.4% 50 mL IV if acidotic\nInsulin 10 units + Dextrose 50% 25 g IV\nSalbutamol nebulization 10–20 mg\nKayexalate (SPS) 15–30 g PO if tolerated\nDialysis if K+ >6.5 or ECG changes"],
        ["Metabolic Acidosis (pH<7.35)", "Treat underlying cause; IV sodium bicarbonate if pH <7.2\nTarget HCO3 ≥15 mEq/L; dialysis if refractory"],
        ["Hyperphosphatemia", "Dietary restriction; phosphate binders (calcium carbonate with meals)"],
        ["Hypocalcemia", "Calcium gluconate 1–2 g IV over 10 min (symptomatic only)"],
        ["Hyponatremia", "Identify cause (dilutional vs. depletion); fluid restrict if dilutional"],
        ["Hyperuricemia", "Usually managed conservatively; colchicine/NSAID avoid; consider rasburicase if TLS"],
    ],
    col_widths=[2.2, 4.2]
)

# ── 7d RRT
p = doc.add_paragraph()
set_heading(p, "7D. Renal Replacement Therapy (RRT) – Indications", level=2)
small_para(doc, "Absolute indications (AEIOU mnemonic):")
for ind in [
    "A – Acidosis: pH <7.2 refractory to bicarbonate therapy",
    "E – Electrolytes: Hyperkalemia >6.5 mEq/L or ECG changes, refractory hyponatremia",
    "I – Intoxication: Methanol, ethylene glycol, salicylates, lithium",
    "O – Overload: Volume overload (pulmonary edema) unresponsive to diuretics",
    "U – Uremia: BUN >100 mg/dL; uremic encephalopathy; uremic pericarditis (friction rub)"
]:
    bullet(doc, ind)

small_para(doc, "RRT Modality Choice:")
add_table(doc,
    headers=["Modality", "Use In"],
    rows=[
        ["IHD (Intermittent HD)",           "Hemodynamically stable patients; rapid solute clearance needed"],
        ["CRRT (CVVHDF / CVVH)",            "Hemodynamically unstable; preferred in ICU; better for volume control"],
        ["SLED (Sustained Low-Efficiency D.)", "Intermediate stability; used in step-down ICU setting"],
        ["Peritoneal Dialysis",              "Resource-limited settings; less preferred in AKI ICU"],
    ],
    col_widths=[2.5, 4.0]
)

kv(doc, "RRT Access", "Double-lumen catheter – Right internal jugular (preferred) / Subclavian / Femoral")
kv(doc, "RRT Initiated", "Yes / No  |  Date/Time: _______________")
kv(doc, "Modality Used", "_________________________________")

# ── 7e Medications to Adjust
p = doc.add_paragraph()
set_heading(p, "7E. Medications Requiring Dose Adjustment / Avoidance in AKI", level=2)
add_table(doc,
    headers=["Drug Category", "Action"],
    rows=[
        ["NSAIDs",                     "STOP – reduce renal blood flow, worsen AKI"],
        ["Metformin",                  "STOP – risk of lactic acidosis (hold until sCr normalizes)"],
        ["ACE inhibitors / ARBs",      "HOLD in acute phase – risk of worsening GFR, hyperkalemia"],
        ["Aminoglycosides",            "AVOID – nephrotoxic; use alternatives"],
        ["Vancomycin",                 "Dose per level + renal function (AUC/MIC monitoring)"],
        ["Contrast agents (IV)",       "AVOID or pre-hydrate + N-acetylcysteine; use LOCA only"],
        ["Low molecular weight heparin","Use UFH; LMWH accumulates in severe AKI (GFR<30)"],
        ["Digoxin",                    "Reduce dose; monitor levels closely"],
        ["Antibiotics (renally cleared)","Adjust doses per GFR (e.g., piperacillin-tazobactam, meropenem)"],
    ],
    col_widths=[2.2, 4.2]
)

# ── 7f Nutrition
p = doc.add_paragraph()
set_heading(p, "7F. Nutrition in AKI", level=2)
for n in [
    "Energy: 20–25 kcal/kg/day (critically ill)",
    "Protein: 1.0–1.5 g/kg/day (non-dialysis AKI);  up to 1.7 g/kg/day (CRRT patients)",
    "Restrict potassium, phosphorus, sodium in diet",
    "Avoid enteral/parenteral supplementation of potassium unless documented hypokalemia",
    "Preferred route: Enteral nutrition (if gut functional); start within 24–48 h of ICU admission",
    "Glycemic control: Target glucose 140–180 mg/dL; avoid hypoglycemia"
]:
    bullet(doc, n)

# ═══════════════════════════════════════════════════════════
# SECTION 8 – DAILY ICU MONITORING CHART
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 8 – DAILY MONITORING & PROGRESS CHART")
add_table(doc,
    headers=["Parameter", "Day 1", "Day 2", "Day 3", "Day 4", "Day 5"],
    rows=[
        ["Weight (kg)",           "", "", "", "", ""],
        ["BP (mmHg)",             "", "", "", "", ""],
        ["MAP (mmHg)",            "", "", "", "", ""],
        ["HR (bpm)",              "", "", "", "", ""],
        ["SpO2 (%)",              "", "", "", "", ""],
        ["UO total (mL/24h)",     "", "", "", "", ""],
        ["Total intake (mL/24h)", "", "", "", "", ""],
        ["Fluid balance (mL)",    "", "", "", "", ""],
        ["Creatinine (mg/dL)",    "", "", "", "", ""],
        ["BUN (mg/dL)",           "", "", "", "", ""],
        ["K+ (mEq/L)",            "", "", "", "", ""],
        ["Na+ (mEq/L)",           "", "", "", "", ""],
        ["HCO3- (mEq/L)",         "", "", "", "", ""],
        ["pH (ABG)",              "", "", "", "", ""],
        ["RRT session",           "", "", "", "", ""],
        ["AKI Stage",             "", "", "", "", ""],
        ["Antihypertensive IV",   "", "", "", "", ""],
        ["Antihypertensive PO",   "", "", "", "", ""],
    ],
    col_widths=[2.2, 0.85, 0.85, 0.85, 0.85, 0.85]
)

# ═══════════════════════════════════════════════════════════
# SECTION 9 – COMPLICATIONS WATCH
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 9 – COMPLICATIONS TO MONITOR")
add_table(doc,
    headers=["Complication", "Signs/Triggers", "Immediate Action"],
    rows=[
        ["Pulmonary Edema",          "Rising FiO2 need, crackles, CXR",         "Furosemide IV / CPAP / RRT if refractory"],
        ["Hyperkalemia (severe)",    "K+ >6.5, ECG: peaked T, wide QRS",        "Calcium gluconate, insulin-dextrose, emergent dialysis"],
        ["Uremic encephalopathy",    "Confusion, asterixis, seizures",           "Emergent RRT"],
        ["Uremic pericarditis",      "Pleuritic chest pain, friction rub",       "Urgent RRT; avoid anticoagulation"],
        ["Hypertensive encephalopathy","Headache, confusion, seizures, BP >>180","IV nicardipine or labetalol; reduce MAP by ≤25% in 1 h"],
        ["Hypertensive Pulmonary Edema","SOB, pink frothy sputum, hypertension", "IV nitroglycerin + loop diuretic; CPAP/NIV"],
        ["Thrombotic Microangiopathy","Low platelets, hemolysis, AKI",           "Nephrology + hematology consult; plasma exchange"],
        ["Sepsis (driving AKI)",     "Fever/hypothermia, WBC rise, cultures +", "Broad-spectrum antibiotics; source control; fluids"],
        ["Post-obstructive AKI",     "Bladder fullness, US: hydronephrosis",     "Urinary catheterization; urology consult"],
    ],
    col_widths=[2.0, 2.3, 2.3]
)

# ═══════════════════════════════════════════════════════════
# SECTION 10 – RECOVERY CRITERIA & DISCHARGE PLANNING
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 10 – RECOVERY CRITERIA & DISCHARGE PLANNING")

p = doc.add_paragraph()
set_heading(p, "Criteria for ICU Step-Down / Discharge Readiness", level=2)
for c in [
    "BP controlled on oral medications (SBP <160 mmHg)",
    "Urine output ≥0.5 mL/kg/hr consistently for >12 h without diuretics",
    "Creatinine trending downward toward baseline",
    "Serum potassium <5.5 mEq/L on oral/no treatment",
    "Metabolic acidosis resolved (pH ≥7.35, HCO3 ≥18)",
    "No active indications for RRT",
    "Patient hemodynamically stable, off intravenous antihypertensives",
    "Patient tolerating oral medications and enteral nutrition"
]:
    bullet(doc, c)

p = doc.add_paragraph()
set_heading(p, "Discharge Medications (Sample)", level=2)
add_table(doc,
    headers=["Drug Class", "Example Agent", "Notes"],
    rows=[
        ["CCB",                 "Amlodipine 5–10 mg PO OD",              "Preferred; renal-safe"],
        ["ACE-I (if eGFR stable)", "Ramipril 2.5–5 mg PO OD",            "After AKI resolved; monitor K+/Cr at 1 week"],
        ["Loop Diuretic",       "Furosemide 40 mg PO OD",                "If residual volume overload"],
        ["Potassium supplement", "KCl 20 mEq PO TID (if hypokalemic)",   "Monitor levels closely"],
        ["Phosphate binder",    "Calcium carbonate 500 mg TID with meals","If persistent hyperphosphatemia"],
        ["Statin",              "Atorvastatin 20–40 mg PO OD",           "Cardiovascular protection; generally safe in AKI recovery"],
    ],
    col_widths=[1.8, 2.4, 2.4]
)

p = doc.add_paragraph()
set_heading(p, "Follow-Up Plan", level=2)
for fu in [
    "Nephrology OPD at 1 week: repeat creatinine, eGFR, electrolytes, urinalysis",
    "BP monitoring: target <130/80 mmHg at 4 weeks",
    "24-h urine protein at 4 weeks (persistent proteinuria → renal biopsy consideration)",
    "Repeat renal ultrasound if obstruction/structural abnormality suspected",
    "Review and reintroduce ACE-I/ARB only after sCr stable ×2 readings",
    "Educate patient: avoid NSAIDs, maintain hydration, BP medication compliance",
    "CKD surveillance if AKI not fully recovered at 3 months"
]:
    bullet(doc, fu)

# ═══════════════════════════════════════════════════════════
# SECTION 11 – PHYSICIAN ORDERS & SIGNATURES
# ═══════════════════════════════════════════════════════════
shaded_heading(doc, "SECTION 11 – ORDERS & SIGNATURES")
add_table(doc,
    headers=["Order Category", "Details", "Signed By", "Date/Time"],
    rows=[
        ["Monitoring",   "Vitals Q1h; strict I&O; daily weights; urine output Q1h", "", ""],
        ["Labs",         "sCr, BUN, electrolytes Q6-12h; CBC daily; ABG Q6h if acidosis", "", ""],
        ["Fluid Orders", "Type: ___  Rate: ___ mL/hr  Duration: ___", "", ""],
        ["Antihypertensive", "Drug: ___  Dose: ___  Route: ___  Frequency: ___", "", ""],
        ["RRT Order",    "Modality: ___  Access: ___  Anticoagulation: ___", "", ""],
        ["Diet",         "Low K+/PO4/Na+  Fluid restrict: ___ mL/day  Protein: ___", "", ""],
        ["Consults",     "Nephrology / Cardiology / Ophthalmology / Other: ___", "", ""],
        ["Nurse Instructions", "Notify if UO <30 mL/hr; K+ >5.5; SBP >180 or <90; O2 sat <92%", "", ""],
    ],
    col_widths=[1.6, 2.8, 1.3, 0.9]
)

doc.add_paragraph()
add_hr(doc)

# Footer note
foot = doc.add_paragraph()
foot.alignment = WD_ALIGN_PARAGRAPH.CENTER
fr = foot.add_run(
    f"Generated: {datetime.date.today().strftime('%B %d, %Y')}  |  "
    "References: KDIGO AKI Guidelines 2012 · Comprehensive Clinical Nephrology 7e · "
    "Fischer's Mastery of Surgery 8e · Washington Manual of Medical Therapeutics · "
    "Brenner & Rector's The Kidney 2e"
)
fr.font.size = Pt(7.5)
fr.font.name = "Arial"
fr.font.color.rgb = RGBColor(0x60, 0x60, 0x60)

out = "/tmp/workspace/icu-file/ICU_AKI_Hypertension.docx"
doc.save(out)
print(f"Saved: {out}")