case 24

44year old male
DOA -21/10/2023
DOD -2/11/2023 
CKD DURATION -4YRS and is on maintenance hemodialysis since 1YR 

DIAGNOSIS -
CKD ON MHD
HYPERTENSION
DIABETES MELLITUS 

Case History and Clinical Findings 

PATIENT CAME WITH
C/O DECREASED OUTPUT AND B/L LEG SWELLING SINCE 1MONTH. C/O SOB SINCE 2 MONTHS.
PATIENT WAS APPRARENTLY ASYMPTOMATIC 2 YEARS BACK THEN HE DEVELOPED B/L PEDAL EDEMA, PITTING TYPE, ASSOCIATED WITH DECREASED U/O AND SOB GRADE 2.

PAST HISTORY 
K/C/O HTN, DM2.
N/K/C/O TB, ASTHAMA, EPILEPSY, CVA

INVESTIGATION 

HB-7.9
 MCV -81.4 
MCH28.5
MCHC 33.2           
TLC -8900
PLT -2.67                

SMEAR -NORMOCYTIC NORMOCHROMIC      

S iron -   48
S.ferritin-264.7
                                                                
CUE-
ALBUMIN +++
SUGAR ++
BILE SALTS

 (LFT)
 Total Bilurubin -0.54 mg/dl
Direct Bilurubin0.20 mg/dl
SGOT(AST)12 IU/L
SGPT(ALT)08 IU/L
ALKALINE PHOSPHATE -293 IU/L
TOTAL PROTEINS -6.1 gm/dl
ALBUMIN. -3.61 gm/dl
A/G RATIO1.45


RFT 
 UREA
37 mg/dl
CREATININE
4.6 mg/dl
URIC ACID
3.1 mg/dl
CALCIUM
10.0 mg/dl
PHOSPHOROUS
2.3 mg/dl
SODIUM
137 mEq/L
POTASSIUM
3.9 mEq/L
CHLORIDE
98 mEq/L

 2D ECHO
MILD TR WITH PAH TRIVIAL AR , TRIVIAL MR NO AS/MS
NO PE/ LV CLOT MILD LVH, EF 56% DILATED LA, DILATED LV GOOD LV FUNCTION
NO DIASTOLIC DYSFUNCTION 

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -1
ADMISSION IN ICU -1




Treatment Given(Enter only Generic Name)
SALT RESTRICTION <2GM/DAY
FLUID RESTRICTION <1.5 LTR /DAY
TAB . OROFER XT PO OD
TAB. TELMA 40 MG PO/OD
TAB LASIX 40 MG PO/BD
TAB. NICARDIA 20 MG PO / TID
INJ. IRON SUCROSE 100 MG IV ONCE WEEKLY INJ. EPO 4000 IU SC ONCE WEEKLY 

Advice at Discharge
SALT RESTRICTION <2GM/DAY FLUID RESTRICTION <1.5 LTR /DAY TAB . OROFER XT PO OD TAB. TELMA 40 MG PO/OD TAB LASIX 40 MG PO/BD TAB. NICARDIA 20 MG PO / TID
INJ. IRON SUCROSE 100 MG IV ONCE WEEKLY INJ. EPO 4000 IU SC ONCE WEEKLY


Follow up at 3months 
HB -7.7
MCV -87.7
MCH -28.4
MCHC -30.7
TLC -7600
PLT -1.98


Follow up at the end of thesis 
HB -8.0
MCV -88.3
MCH -29.4
MCHC -29.9
TLC -7800
PLT -2.0


                                                                                                                                                                                                                                                              

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