case 15

54 year old male
DOA -26/12/2023
DOD -17/1/2023
Duration of CKD -2months and since then was on maintenance hemodialysis 

Diagnosis 
CKD ON MHD

Case History and Clinical Findings
 C/O B/L PEDAL EDEMA SINCE 2 MONTHS C/O SOB GRADE III.
HOPI;- PATIENT WAS APPARENTLY ASYMPTOMATIC SINCE 10 DAYS. THEN HE DEVELOPED BILATERAL SWELLINGS OF LOWER LIMBS. C/O SOB GRADE III PROGRESSIVE 


PAST HISTORY:
K/C/O CKD since 2months
K/C/O HTN SINCE 10 YEARS USES MEDICATION K/C/O DM SINCE 5 YEARS (ON MEDICATION) N/K/C/O ASTHMA, TB, EPILEPSY, CAD 

GENERAL EXAMINATION 
PT IS C/C/C 
BP-160/80MMHD 
PR-106BPM
 SPO2-82
 RR-23CPM
GRBS- 132MG/DL
SYSTEMIC EXAMINATION
 CVS-S1S2+ 
RS-NVBS
CNS-NFND
P/A- SOFT ,NT


Investigation
CBP
 HB-7.4 
MCV -82.1
MCH -27.4
MCHC -32.0
TC-8000 
PLT-2.0

S iron -58
S.ferritin-118.4

RFT
 URea-129 
CReatinine-8.9 
NA 140 
K 3.6 
CL 101 
CA 10
 PO4 4


LFT
 TB 0.77
 DB 0.17 
AST 16
 ALT 10
 ALP 176
 TP 6.8 
ALB 2.8
CUE
COLOUR YELLOW
ALBUMIN ++++
SUGAR +
RBC NIL
CASTS NIL
S


USG
B/L GRADE 2 RPD CHANGES


2D ECHO
TRIVIAL TR, NO AS/MS, SCLEROTIC AV
EF 63%, GOOD LV FUNCTION
GRADE 1 DIASTOLIC DYSFUNCTION
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 -1
ADMISSION IN ICU -1 
( Due to pulmonary odema)


Treatment Given(Enter only Generic Name)
TAB. LASIX 80MG PO BD
TAB. NICARDIA 20 MG/TID
TAB.OROFER XT PO OD
TAB.TELMA 80 MG/OD
TAB. SHELCAL CT 500MG PO OD
FLUID RESTRICTION AND SALT RESTRICTION
INJ.IRON SUCROSE 100 MG/ONCE IN 2 WEEKS
INJ.EPO 4000 IU/ONCE IN 2WEEKS


Advice at Discharge
TAB. LASIX 80MG PO BD
TAB. NICARDIA 20 MG/TID TAB.OROFER XT PO OD TAB.TELMA 80 MG/OD
TAB. SHELCAL CT 500MG PO OD FLUID RESTRICTION AND SALT RESTRICTION INJ.IRON SUCROSE 100 MG/ONCE IN 2 WEEKS INJ.EPO 4000 IU/ONCE IN 2WEEKS


Follow up at the end of 3months 
Patient has expired at home possibly due to acute pulmonary odema.

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