CASE 42

55year old male 
DOA -4/10/2024
DOD -8/10/2024
CKD DURATION -not known and is on maintenance hemodialysis since 6months 


DIAGNOSIS 
CHRONIC KIDNEY DISEASE ON MAINTENANCE HEMODIALYSIS 

Case History and Clinical Findings
CAME TO CASUALTY WITH 
C/O DECREASED URINE OUTPUT SINCE 10DAYS
 
HOPI: PATIENT WAS APPARENTLY ASSYMPTOMATIC TILL 10DAYS THEN HE DECREASED URINE OUTPUT INSIDIOUS ONSET, GRADUALLY PROGRESSIVE  AND 
H/O PEDAL ODEMA PRESENT SINCE 1YEAR PITTING TYPE ON AND OFF 

Ki NO H/O FEVER, COUGH,COLD
NO H/O CHEST PAIN ,PALPITATIONS, BREATHLESSNESS,ORTHOPNEA,PND 


PAST HISTORY:
N/K/C/O HTN,DM,EPILEPSY,ASTHMA,CVA,CAD


 Investigation
HB -12.6
MCV -82.5
MCH 29
MCHC 35.1
TLC -11000
PLT -2.41

SMEAR -NORMOCYTIC NORMOCHROMIC 

S.iron-72.
S.ferritin -264.8



BLOOD UREA - 129 mg/dl
SERUM CREATININE 8.3 mg/dl
SODIUM 132 mmol/L
POTASSIUM 3.6 mmol/L
CHLORIDE 96 mmol/L


COMPLETE URINE
ALBUMIN +
SUGAR Nil
 

LFT 
Total Bilurubin 1.43 mg/dl
Direct Bilurubin 0.33mg/dl
SGOT(AST) 18 IU/L
SGPT(ALT) 13 IU/L
ALKALINE PHOSPHATASE 87 IU/L
TOTAL PROTEINS5.8 gm/dl
ALBUMIN 3.3 gm/dl
A/G RATIO 1.32

2D ECHO -EF -56% LVH PRESENT 

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)
FLUID RESTRICTION LESS THAN 1LIT /DAY
SALT RESTRICTION LESS THAN 2GM DAY 
 INJ LASIX 40 MG IV/od  
 T SHELCAL CT PO/OD
 T PAN 40 MG PO/OD
 TAB MVT PO/OD 0-1-
TAB.NODOSIS 500MG BD
INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD ALTERNATE DAY 
INJ EPO 4000 IU SC WEEKLY ONCE 


 Advice at Discharge
FLUID RESTRICTION LESS THAN 1LIT /DAY
SALT RESTRICTION LESS THAN 2GM DAY 
 T SHELCAL CT PO/OD
TAB.NODOSIS 500MG BD
 T PAN 40 MG PO/OD
 TAB MVT PO/OD 0-1-0
INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD ALTERNATE DAY 
INJ EPO 4000 IU SC WEEKLY ONCE 


Follow up at 3months -patient has expired due to ? CLABSI

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