case 23

50year old male
DOA -7/4/2023
DOD -4/5/2023
CKD DURATION -3years 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 SINCE4MONTHS AND C/O BILATERAL PEDAL EDEMA SINCE 4MONTHS.

 HOPI :
PATIENT WASAPPARENTLY ASYMPTOMATIC 3YEARS BACK THEN HE DEVELOPED DECREASED URINE OUT PUT AND ALSO BILATERAL PEDAL EDEMA(PITTING TYPE , TILL KNEE ) A/W SOB,INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE GRADE II MMRC , MORE DURING NIGHT TIME
NO H/O BURNING MICTURITION,FRITHY URINE ,HEMATURIA. NO H/O CHEST PAIN,PALPITATIONS,SYNCOPAL ATTACKS AND PND,ORTHOPNEA. NO H/O COLD,COUGH AND FEVER. 

PAST HISTORY;
K/C/O HTN SINCE 5 YRS ON TAB METXL 50MG K/C/O DM 2 SINCE 3 YRS ON INSULIN N/K/KC/O 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,
B/L PEDAL EDEMA+
VITALS;
TEMP; AFEBRILE
PR;98BPM
RR;20CPM
BP;150/80MMHG
GRBS;124MG/DL
SPO2;93 AT 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 -10.2
MCV -90.2
MCH -27.5
MCHC -34.7
TLC -5500
PLT -1.6


UREA-67
CREATININE- -6.7
Na+ -143
K+ -4.3
Cl-102

ECG - NORMAL

S iron -37.2
S.ferritin-372.1

USG ABDOMEN
IMPRESSION : BILATERAL GRADEIII RPD CHANGES.


2D ECHO
DILATED RA, RV, LA AND LV
CONCENTRIC LVH
RWMA+, ANTERIOR WALL HYPOKINESIA
MINIMAL PE
MILD MR,AR, TR WITH PAH
MILD LV DYSFUNCTION
EF 49%
GRADE I 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 <1.5 LIT/DAY
SALT RESTRICTION <2.5GM/DAY
TAB. LASIX 80MG PO/BD
TAB. NICARDIA 20MG PO/TID 
TAB. SHECAL CT 500MG PO/OD
 TAB. TELMA 80 MG PO/OD
 TAB. MET XL 25 MG PO/OD 
TAB. ARKAMINE 0.1 MG PO/TID
INJ. IRON SUCROSE 100MG IV ONE IN 2 WEEKS INJ. EPO 4000 IU SC/ ONCE IN 2 WEEKS 

Advice at Discharge
FLUID RESTRICTION <1.5 LIT/DAY SALT RESTRICTION <2.5GM/DAY 
TAB. LASIX 80MG PO/BD
 TAB. NICARDIA 20MG PO/TID
 TAB. SHECAL CT 500MG PO/OD 
TAB. TELMA 80 MG PO/OD 
TAB. MET XL 25 MG PO/OD 
TAB. ARKAMINE 0.1 MG PO/TID
INJ. IRON SUCROSE 100MG IV Once a week
INJ. EPO 4000 IU SC/ ONCE IN 2 WEEKS

Follow up at 3months 
HB -8.4
MCV -86.7
MCH -27.1
MCHC -30.3
TLC -9000
PLT -3.1

Follow up at the end of thesis 
Patient has expired - at home 
? Pulmonary odema 

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