case 17

62year old male
DOA -28/12/2023
DOD -17/1/2024
Duration of CKD -1year and is on maintenance hemodialysis since 6months

Diagnosis
 CKD ON MHD


Case History and Clinical Findings 
C/O B/L PEDAL EDEMA SINCE 20 DAYS C/O SOB SINCE 16 DAYS

HOPI;-
 PATIENT WAS APPARENTLY ASYMPTOMATIC SINCE 20 DAYS BACK, THEN HE DEVELOPED BILATERAL PEDAL EDEMA, SOB GRADE III PROGRESSIVE K/C/O HTN SINCE 3 YEARS USES MEDICATION.
 H/O NSAID ABUSE
N/K/C/O DM, ASTHMA, EPILEPSY, TB, CVA 

GENERAL EXAMINATION 
PT IS C/C/C 
BP-120/70MMHg
 PR-88BPM 
SPO2-97 
RR-19CPM
SYSTEMIC EXAMINATION
 CVS-S1S2+ 
RS-NVBS
 CNS-NFND 
P/A- SOFT ,NT


Investigations 

CBP
 HB-7.5 
MCV -84.3
MCH -30.7
MCHC -36.4
TC-7000 
PLT-2.3 

S.IRON-60
S.FERRITIN-214.3

RFT 
UREA-105 
CREATININE-5.2
NA-135
K-3.5
CL-98


2D ECHO TRIVIAL MR; NO AS/MS NO RWMA
EF 64%; GOOD LV FUNCTION NO DIASTOLIC DYSFUNCTION NO PE/LV CLOT

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -0
ADMISSION IN ICU -0


Treatment Given(Enter only Generic Name) TAB.OROFER XT PO OD
 TAB. SHELCAL PO OD
 TAB. LASIX 40MG PO BD 
TAB.MET-XL 25MG PO OD 
TAB. NICARDIA RETARD 20 MG TID
 TAB. TELMA 80 MG PO OD
FLUID RESTRICTION 
 SALT RESTRICTION

 Advice at Discharge 
TAB.OROFER XT PO OD 
TAB. SHELCAL PO OD
 TAB. LASIX 40MG PO BD 
TAB.MET-XL 25MG PO OD
 TAB. NICARDIA RETARD 20 MG TID 
TAB. TELMA 80 MG PO OD
FLUID RESTRICTION
SALT RESTRICTION


Follow up at 3months 
HB -8.7
MCV -83.4
MCH -28.1
MCHC -30.4
TLC -8700
PLT -2.13

Follow up at the end of thesis 
HB -9.1
MCV -85.1
MCH -29.7
MCHC -35.6
TLC -9800
PLT -2.4




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