case 22

67 year old female
DOA -27/10/2023
DOD -14/11/2023
Ckd DURATION -1 year and is on maintenance hemodialysis since 6months

Diagnosis -
CKD ON MHD 
HYPERTENSION 

Case History and Clinical Findings

 C/O PEDAL EDEMA SINCE 30 DAYS C/O FACIAL PUFFINESS SINCE 15 DAYS.


HOPI-
 PT WAS APPARANTLY ASSYMPTOMATIC 30 DAYS BACK THEN SHE DEVELOPED PEDAL EDEMA WHICH IS PITTING TYPE , EXTENDING UPTO KNEE JOINT EXTERNAL SOB , PROGRESSEDFROM GRADE I TO GRADE III N/H/O DECREASED URINE OUTPUT

 PAST HISTORY -
CKD SINCE 1 YEAR
 K/C/O HTN SINCE 1 YEAR
 N/K/C/O/ DM, BRONCHAL ASTHMA , TB, EPILEPSY , CAD, CVA
 PAST SURGICAL H/O- TUBECTOMY 40 YEARS BACK 

PERSONAL HISTORY 
: DIET :MIXED
APPETITE : GOOD
 SLEEP : ADEQUATE 
BOWEL:: REGULAR
ALCOHOL - STOPPED 2 YEARS AGO 


GENERAL EXAMINATION : PATIENT IS CONSCIOUS , COHERENT , COOPERATIVE PALLOR- PRESENT
PEDAL EDEMA- GRDAE 2 TO 3
NO SIGNS OF CLUBBING , ICTERUS , CYANOSIS , LYMPHEDNOPATHY,
VITALS :
TEMP : 96.8 F
PR : 84 BPM
BP : 170/110 MMHG
GRBS : 148 MG / DL
SPO2 : 97%
RR : 28 CPM
SYSTEMIC EXAMINATION :
CVS : S1 , S2 HEARD , NO MURMURS
RS : BAE + , NVBSHEARD
PA :SOFT,NT, NO O
RGANOMEGALY
Investigation
BLOOD UREA-175 mg/dl
SERUM CREATININE 10.2 MG/DL
NA-130
K+ -3.9
CL-101


HB -5.5
MCV -80.1
MCH -24.2
MCHC -29
TLC -6300
PLT -1.9

SMEAR -NORMOCYTIC NORMOCHROMIC 

S iron -56
S.ferritin-128.3


COMPLETE URINE EXAMINATION (CUE) 
ALBUMIN -+++
SUGAR -Nil

LIVER FUNCTION TEST (LFT)

  Total Bilurubin-0.62 mg/dl
Direct Bilurubin-0.19 mg/dl
SGOT(AST)-20 IU/L
SGPT(ALT) -18 IU/L
ALKALINE PHOSPHATE-239 IU/L
TOTAL PROTEINS-6.0 gm/dl
ALBUMIN-3.2 gm/dl
A/G RATIO-1.2

2D ECHO -EF-60%
GRADE 1 DIASTOLIC DYSFUNCTION.

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEKS
PRBC TRANSFUSED -3
ADMISSION IN ICU -1 due to pulmonary odema 


Follow up at 3months 
HB -7.7
MCV -83.7
MCH -28.2
MCHC -32.1
TLC -8000
PLT -2.14

Follow up at the end of thesis 
HB -7.0
MCV -82.6
MCH -27.9
MCHC -31.3
TLC -8500
PLT -2.34

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