case 21

60year old male
DOA -5/3/2024
DOD -11/3/2024
CKD DURATION -4years and is on maintenance hemodialysis since 

Diagnosis -
CHRONIC RENAL FAILURE 

Case History and Clinical Findings 

C/O B/L PEDAL EDEMA SINCE 3MONTHS C/O LOSS OF APPETITE SINCE 1MONTH

HOPI:PT WAS APPARENTLY ASYMPTOMATIC 3MONTHS BACK THEN DEVELOPED B/L PEDAL EDEMA WHICH IS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE,PITTING TYPE OF EDEMA UPTO THE KNEES.
C/O LOSS OF APPETITE SINCE 1 MONTH NO H/O FEVER,NAUSEA,VOMITING
NO H/O ABDOMINAL PAIN,BURNING MICTURITION NO H/O INVOLUNTARY MICTURATION AND DEFECATION NO H/O INVOLUNTARY MOVEMENTS NO H/O SOB,ORTHOPNEA,PND NO H/O BLEEDING MANIFESTATION .

PAST HISTORY
K/C/O HTN SINCE 1 YEARS (NON COMPLIANT TO DRUGS)
 N/K/C/O DM,EPILEPSY,ASTHMA,CAD,CVA AND THYROID DISORDERS

 GENERAL EXAMINATION
NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,
LYMPHADENOPATHY ,OEDEMA OF FEET IS PRESENT
 TEMP-98.2 F 
PR-88BPM
BP-150/80 MM HG
SPO2 98% @RA
CVS - S1S2 HEARD,NO MURMURS
RS - BAE PRESENT
P/A - SOFT ,NON TENDER NO ORGANOMEGALY
CNS - NFND
IN TOTAL 4 SESSIONS OF DIALYSIS DONE UROLOGY REFERRAL DONE ON 8/3/24 I/V/O AV
FISTULA
ADVISED:
B/L UPPER LIMB DOPPLER FOR AV FISTULA CREATION
-B/L UPPER LIMB STRESS BALL PHYSIOTHERAPY X 2WEEKS
-AVOID LEFT UPPER LIMB IV CANNULATION.
CENTRAL LINE WAS SECURED ON 5/3/24
Investigation
HEMOGRAM
HB-4.7
TLC-5400
N/L/E/M/B- 65/22/03/10/00
PCV-14.2
MCV-76.8
MCH-27.3
MCHC-33.1
RDW-CV:18.8
RDW-SD:56.9
RBC COUNT-1.72
PLATELET COUNT-1.4


SERUM IRON-54
S.FERRITIN -412.4

RBS-137MG/DL
BLOOD GROUP-B POSITIVE
BLOOD UREA - 239 mg/dl
SERUM CREATININE- 13.3 mg/dl
 
CUE-

 ALBUMIN +++
SUGAR Nil

USG ABDOMEN AND PELVIS DONE ON 5/3/24
IMPRESSION:
-B/L GRADE-III RPD CHANGES

2D ECHO
TRIVIAL AR, TRIVIAL MR, TRIVIAL TR WITH PSH
EF 66%, GOOD LV FUNCTION
GRADE I DFIASTOLIC DYSFUNCTION
MILD CONCENTRIC LVH
NO RWMA, 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 -4
ADMISSION IN ICU -2( due to pulmonary odema and one more admission for CVA)

Treatment Given(Enter only Generic Name)
FLUID RESTRICTION LESS THAN 1.5 L/DAY
SALT RESTRICTION LESS THAN 2-3 GM/DAY
TAB.LASIX 80 MG PO BD
INJ.EPO 4000 IU S/C ONCE A WEEK
INJ.IRON SUCROSE 100 MG IN 100 ML NS IV OD
TAB.NICARDIA 20 MG PO TID
TAB.TELMA 80 MG PO OD
TAB.OROFER-XT PO OD 
TAB.SHELCAL-CT PO OD 
TAB MET XL 25MG PO /OD 


Advice at Discharge
FLUID RESTRICTION LESS THAN 1.5 L/DAY SALT RESTRICTION LESS THAN 2-3 GM/DAY TAB.LASIX 80 MG PO BD
INJ.EPO 4000 IU S/C ONCE A WEEK INJ.IRON SUCROSE 100 MG IN 100 ML NS IV OD TAB.NICARDIA 20 MG PO TID 
TAB.TELMA 80 MG PO OD 
TAB.OROFER-XT PO OD 
TAB.SHELCAL-CT PO OD 
TAB MET XL 25MG PO /OD
 

Follow up at 3months -
HB -6.0
MCV -83.4
MCH -26.1
MCHC -32.1
TLC -10,100
PLT -2.1

Follow up at the end of thesis -
Patient has expired-  possibly due to CVA and pulmonary odema 

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