case 16

42year old male
DOA -22/8/2023
DOD -3/10/2023
CKD DURATION -4years and is on maintenance hemodialysis since 3years.

Diagnosis 
CKD ON MHD
Case History and Clinical Findings
C/O PEDAL EDEMA SINCE 4 years on and off
AND DECREASED APPETIE SINCE 15 DAYS.
DECREASED URINE OUTPUT SINCE 15DAYS.

 HOPI -
 PT. WAS APPARENTLY ASYMPTOMATIC 4 YEARS BACK THEN HE DEVELOPED PEDAL EDEMA , PITTING TYPE BELOW KNEE , DECREASED APPETITE , SOB +GRADE 2 WITH DECREASED URINE OUTPUT 15 DAYS BACK THEN HE DEVELOPED DECRESED APPETITE H/O SOB GRADE 2, H/O DECREASED URINEOUTPUT  SINCE 15DAYS
NO H/O HEMATURIA , FEVER , COUGH.

PAST H/O -
 PT. IS K/C/O HTN SINCE 4YEARS AND ON IRREGULAR MEDICATION . NO H/O DM, ASTHAMA,EPILEPSY , TB , CVD. 

GENERAL EXAMINATION:
THE PATIENT IS CONSCIOUS, COHERENT, COOPERTIVE MODERATELY BUITL AND NOURISHED OEDEMA OF FEET PRESENT
NO SIGNS OF PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY VITALS:
TEMP: AFEBRILE
 PR: 89 BPM
 RR: 20 CPM
BP: 110/70 MM HG 
SPO2: 98% @ RA
 GRBS: 92 MG/DL
CVS: S1,S2 HEARD, NO MURMURS
RS: NVBS
PA: SOFT AND NON TENDER
CNS: NFND


Investigation
CBP
HB: 7.6 GM/DL
MCV -85.6
MCH -26.1
MCHC -34.8
TC: 7000 CELLS CU/MM
PLT: 2.24 LAKHS CU/MM

RFT
UR: 129 MG/DL
CR: 5.9 MG/DL
UA: 9.6 MG/DL
CA+2: 9.6 MMOL/L
P: 3.4 MG/DL
NA+:138 MEQL
K+: 4.4 MEQL
CL-: 101 MEQL

HIV: NEGATIVE
HBSAG: NEGATIVE
HCV: NEGATIVE
RBS- 96MG/DL

SMEAR -NORMOCYTIC NORMOCHROMIC 
SERUM IRON - 36.4
S.FERRITIN -380.9
BGT RH TYPING - O POSITIVE

ULTRASOUND IMPRESION -
B/L GRADE 3 RPD CHANGES

2D ECHO- TRIVIAL AR ,TRIVIAL TR WITH PAH
NO RWMA
MILD CONCENTRIC LVH
EF 64 %,GOOD LV FUNTION
NO DIASTOLIC DYSFUNTION ,NO LV CLOT /PE

NTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEKS
PRBC TRANSFUSED -1
ADMISSION IN ICU-0


Treatment Given(Enter only Generic Name)

1.FLUID RESTRICTION <1L/DAY
2. SALT RESTRICTION <2G/DAY 
3.T.TELMA 40MG PO/OD
 4.T.LASIX 80 MG PO /TID 
5.T. OROFER PO/OD 
6.T.SHELCAL PO/OD
7.CAP BIO D3 PO/ ONCE A WEEK 
8.T.NICARDIA 20MG PO/TID 
9.T. MET XL 25 MG PO/OD
10. INJ. IRON SUCROSE 100 MG IV/ ONCE IN 2 WEEKS
 11. INJ. EPO 4000 IU SC /ONCE IN 2 WEEKS 

Advice at Discharge
1.FLUID RESTRICTION <1L/DAY
 2. SALT RESTRICTION <2G/DAY 
3.T.TELMA 40MG PO/OD
 4.T.LASIX 80 MG PO /TID 
5.T. OROFER PO/OD 
6.T.SHELCAL PO/OD
7.CAP BIO D3 PO/ ONCE A WEEK
 8.T.NICARDIA 20MG PO/TID 
9.T. MET XL 25 MG PO/OD
10. INJ. IRON SUCROSE 100 MG IV/ ONCE IN 2 WEEKS 
11. INJ. EPO 4000 IU SC /ONCE IN 2 WEEKS

Follow up at the end of 3months 
HB -8.0
MCV -88.2
MCH -25.8
MCHC -30.6
TLC -7800
PLT -2.10

Follow up at the end of thesis 
HB -8.2
MCV -89.3
MCH -25.4
MCHC -29.9
TLC -8200
PLT -2.12

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