case 14

55year old male
DOA -8/12/2023
DOD -15/12/2023
Duration of CKD -15years and since 5months is  on maintenance hemodialysis.


Diagnosis 
CKD
ANEMIA 2 TO CKD

Case History and Clinical Findings

 COMPLAINTS OF PEDAL EDEMA SINCE 15DAYS SOB SINCE 10DAYS
PATIENT WAS APPARENTLY ASYMPTOMATIC 15 DAYS BACK THE HE DEVELOPED SOB NOT A/W COUGH, COLD, SORE THROAT. PEDAL EEMA PITTING TYPE BELOW THE KNEE.
NO H/O DECREASED URINE OUTPUT, NSAID ABUSE, HEMATURIA, PYURIA.


Past history 

 K/C/O HTN SINCE 15YRS, CKD SINCE 15years 5months  N/K/C/O DM,CVA,CAD,TB,EPILEPSY

. GENERAL EXAMINATION: 
PT IS C/C/C
PALLOR PRESENT, OEDEMA OF FEET PRESENT. NO ICTERUS, CYANOSIS, KOILONYCHIA, LYMPHADENOPATHY 
TEMP: 98.3 F 
PR: 80 BPM
 RR: 21
BP 140/90
 CVS S1 AND S2 HEARD 
CNS NFND
GIT SOFT NON TENDER , NO ORGANOMEGALY
RS BAE +
Investigation


BLOOD UREA-178 mg/dl
SERUM CREATININ -12.5mg/dl
SODIUM140 mEq/L
POTASSIUM4.6 mEq/L
CHLORIDE104 mEq/L
CALCIUM IONIZED1.13mmol/L

COMPLETE BLOOD PICTURE (CBP)  HAEMOGLOBIN5.0gm/dl
MCV-80.2
MCH-27.2
MCHC-31.3
TLC-5500 
PLATELET COUNT1.60

S iron -42
S.ferritin-390.3

SMEAR. 
Normocytic normochromic

CUE
ALBUMIN+++
SUGARTrace

LIVER FUNCTION TEST (LFT) 
 Total Bilurubin-0.59 mg/dl
Direct Bilurubin0.21 mg/dl
SGOT(AST)24 IU/L
SGPT(ALT)19 IU/L
ALKALINE PHOSPHATE217 IU/L
TOTALBPROTEINS-5.8 gm/dl
ALBUMIN3.51 gm/dl
A/G RATIO1.53


2D ECHO
TRIVIAL MR, TRIVIAL TR WITH PAH, MILD AR
NO AS/MS
DILATE LV AND LA
MODERATE CONCENTRIC LVH,
EF 54, GOOD LV FUNCTION
GRADE I DIASTOLIC DYSFUNCTION
NO RWMA, NO PE/ LV CLOT

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEKS
PRBC TRANSFUSED -4
ADMISSION IN ICU -1 due to pulmonary odema 

Treatment Given(Enter only Generic Name) - TAB. LASIX 80 MG PO BD - 
TAB. TELMA 80 MG PO OD - 
TAB. NICARDIA 20MG PO TID -
 TAB. OROFER XT PO OD 
TAB. SHELCAL CT PO OD
- INJ. EPO 4000U SC OD ONCE IN 2WEEKS - INJ. IRON SUCROSE 100MG IN 100ML ONCE IN A WEEK SALT RESTRICTION<2GM/DAY FLUID RESTRICTION <1L/DAY

 Advice at Discharge 
 TAB. LASIX 80 MG PO BD 
TAB. TELMA 80 MG PO OD 
 TAB. NICARDIA 20MG PO TID
 TAB. OROFER XT PO OD 
TAB. SHELCAL CT PO OD
- INJ. EPO 4000U SC OD ONCE IN 2WEEKS - INJ. IRON SUCROSE 100MG IN 100ML ONCE IN A WEEK SALT RESTRICTION<2GM/DAY FLUID RESTRICTION <1L/DAY


Follow up at the 3months - patient has expired due to myocardial infarction.

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