case 20-

51year old male
DOA -14/8/2023
DOD -30/9/202
Duration of CKD -1month and since then was on maintenance hemodialysis.

Diagnosis
 CKD ON MHD


Case History and Clinical Findings
 K/C/O CKD ON HAEMODIALYSIS C/O SWELLING OF FACE +
H/O SOB GRADE 2 -3, SWELLING OF BOTH LEGS. HOPI:
C/O DM SINCE 5 YEARS
SEVERE DYSPNEA UNDERGONE HAEMODIALYSIS OUTSIDE, RECENTLY 3 TIMES HAEMODIALYSIS AND AV FISTULA CONSTRUCTION

 PAST HISTORY:
K/C/O DM SINCE 15 YEARS .
K/C/O HTN SINCE 2 YEARS.

 GENERAL EXAMINATION:
PT IS C/C/C, WELL BUILT AND NOURISHED
NO SIGNS OF PALLOR, ICTERUS, CYANOSIS,CLUBBING, LYMPHADENOPATHY, BILATERAL PEDAL EDEMA.

 VITALS:
TEMP: AFEBRILE
 PR: 86BPM
 RR: 19CPM
BP: 130/80 MMHG 
SYSTEMIC EXAMINATION: 
CVS:S1 S2+, NO MURMURS
RS: BLAE+,NVBS
CNS: NFND
P/A: SOFT, NON TENDER.


Investigation
CBP
HB-9.6
MCV -87.5
MCH -28.6
MCHC -32.4
TC-7200
PLT - 2.18
SMEAR- NORMOCYTIC NORMOCHROMIC 

S.Iron-58
s.ferritin-354.4


RFT
UREA-209
CREATININE-8.6
UA-11.1
CA+2-9.4
P-7.2
NA+-138
K+-3.8
CL-104.

USG ABDOMEN-
GRADE 3 RPD CHANGES NOTEDIN B/L KIDNEYS.

2D ECHO-
EF -45%
RWMA, LAD HYPOKINESA 
MILD CONCENTRIC LVH
GRADE 2 DIASTOLIC DYSFUNCTION,


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 <1L/DAY SALT CONSUMPTION <2GM/DAY
 TAB.TELMA 40MG PO/OD
 TAB.LASIX 40MG PO/BD 
TAB. METAPROLOL 25 MG PO/OD TAB.OROFER XT PO/BD
 TAB.SHELCAL PO/OD
 CAP RIO D3 PO/ONCE A WEEK
INJ.ERYTHROPOIETIN 4000IU/SC/ONCE IN 2WEEKS .
INJ IRON SUCROSE 100 MG IV ALTERNATE DIALYSIS .


Advice at Discharge -

FLUID RESTRICTION <1L/DAY 
SALT CONSUMPTION <2GM/DAY 
TAB.TELMA 40MG PO/OD
 TAB.LASIX 40MG PO/BD
 TAB. METAPROLOL 25 MG PO/OD TAB.OROFER XT PO/BD
 TAB.SHELCAL PO/OD CAP RIO D3 PO/ONCEA WEEK
INJ.ERYTHROPOIETIN 4000IU/SC/ONCE IN 2 WEEKS
 INJ IRON SUCROSE 100 MG IV ALTERNATE DIALYSIS.


HB at the end of 3months 
HB -8.4
MCV -86.4
MCH -27.8
MCHC -31.5
TLC -7400
PLT -2.5


HB at the end of thesis 
HB -7.9
MCV -89.3
MCH -28.1
MCHC -30.8
TLC -8600
PLT -2.41

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