case 18


42year old male
DOA -10/4/2023
DOD -4/5/2023
CKD DURATION -6years and is on maintenance hemodialysis since 1year


Diagnosis 
CKD ON MHD


Case History and Clinical Findings
PATIENT CAME WITH C/O DECREASED URINE OUT PUT SINCE 2WEEKS AND C/O DECREASED APPETITE SINCE 2WEEKS

 HOPI :
PATIENT WASAPPARENTLY ASYMPTOMATIC 2WEEKS BACK THEN HE DEVELOPED DECREASED URINE OUT PUT AND ALSO DECREASED APPETITE NO H/O BURNING MICTURITION, FROTHY URINE ,HEMATURIA. NO H/O CHEST PAIN,PALPITATIONS,SYNCOPAL ATTACKS AND PND,ORTHOPNEA. NO H/O PEDAL EDEMA , FACIAL PUFFINESS NO H/O PAIN ABDOMEN, NAUSEA ANDVOMITINGS NO H/O COLD,COUGH AND FEVER.

 PAST HISTORY;
K/C/O HTN SINCE 6YRS ON TAB TELMA 40MG N/K/KC/O DM ,ASTHMA, TB , EPILEPSY , CVD, CAD .

PERSONAL HISTORY :
 DIET - MIXED
APPETITE - NORMAL 
SLEEP - ADEQUATE BOWEL - REGULAR
BLADDER- DECREASED URINE OUT PUT.


 FAMILY HISTORY - INSIGNIFICANT
GENERAL EXAMINATION -NO SIGNSOF PALLOR ,ICTERUS ,CYNOSIS, CLUBBING
,LYMPHEDENOPATHY, PEDAL EDEMA
VITALS;
TEMP; AFEBRILE
PR;82BPM
RR;18CPM
BP;130/80MMHG
GRBS;104MG/DL
SPO2;98AT RA
SYSTEMICEXAMINATIOEN;
RS;BAE+,NVBS HEARD
CVS; S1 S2 + ,NO MURMURS
P/A;SHAPE OFTHE ABDOMEN OBESE,UMBILICUS CENTRE,INVERTED,
SOFT AND NON TENDER NO ORGANOMEGALY.
CNS;NFND,HMF+


Investigation-
HB -8.2
MCV -82.3
MCH -27.8
MCHC-33.8
TLC -8500
PLT -2.75

S.iron-70.8
S.ferritin-332.1

SMEAR -NORMOCYTIC NORMOCHROMIC 

USG ABDOMEN -
IMPRESSION - BILATERAL GRADE III RPD CHANGES.

2D ECHO
MILD TR +TRIVIAL AR+/MR+
NO RWMA , NO AS/MS, EF 61%
GOOD LV SYSTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION , NO PAH/PE.

ECG - NORMAL

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)
SALT RESTRICTION DIET <2GM/DAY
FLUID RESTRICTION <1.5 LIT /DAY
TAB. NICARDIA 20MG PO/TID
TAB. TELMA 40MG PO/OD
TAB. LASIX 80MG PO/BD
TAB .SHELCAL 500MG PO/OD
INJ. IRON SUCROSE 100 MG IV ONCE IN 3 WEEKS
INJ. EPO 4000 IU SC ONCE IN 2 WEEKS

Advice at Discharge

SALT RESTRICTION DIET <2GM/DAY
 FLUID RESTRICTION <1.5 LIT /DAY
 TAB. NICARDIA 20MG PO/TID 
TAB. TELMA 40MG PO/OD 
TAB. LASIX 80MG PO/BD 
TAB .SHELCAL 500MG PO/OD
INJ. IRON SUCROSE 100 MG IV ONCE IN 3 WEEKS 
INJ. EPO 4000 IU SC ONCE IN 2 WEEKS

Follow up at 3months 
HB -8.9
MCV -80.4
MCH -27..1
MCHC -32.7
TLC -9000
PLT -2.4

Follow up at end of thesis 
HB -9.0
MCV -81.3
MCH -27.4
MCHC -31.8
TLC -8600
PLT -2.60

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