case 25

40year old female 
DOA -1/11/2023
DOD -12/12/2023
CKD DURATION -6months and since then is on maintenance hemodialysis 

Diagnosis 
CKD ON MHD

Case History and Clinical Findings
C/O PEDAL EDEMA SINCE 6MONTHS,SOB SINCE 3 DAYS 

HOPI:
PATIENT WAS APPARANTLY ASYMPTOMATIC 6 MONTHS BACK THEN SHE DEVELOPED PEDAL EDEMA WHICH WAS PITTING TYPE,EXTENDING UPTO KNEE JOINT SINCE 3 DAYS.SHE DEVELOPED SHORTNESS OF BREATH WHICH WAS INSIDIOUS IN ONSET ,GRADUALLY PROGRESSIVE PROGRESSED FROM GRADE 2 TO GRADE 4 ,AGGREVATED ON EXERTION ,ORTHOPNEA + NO PND ,NO SEASONAL VARIATION ,NO DIURNAL VARIATION.DECREASED URINE OUTPUT SINCE 3 MONTHS.NO H/O FEVER ,COUGH,VOMITINGS ,LOOSE STOOLS,PAIN ABDOMEN ,GIDDINESS,CHESTPAIN ,PALPITAIONS,EXCESSIVE SWEATING 

PAST HISTORY -
K/C/O CKD ON MHD SINCE 6MONTHS 
K/C/O HTN SINCE 4 YRS
N/K/C/O CVA,THYROID ,ASTHMA,EPILEPSY 


O/E:
PT IS C/C/C 
PR:78
BP:150/80 MMHG 
RR:17
SPO2:98% ON RA 
CVS:S1 S2 + NO MURMURS 
RS:BAE+ NVBS
P/A:SOFT NON TENDER
CNS:NFND


Investigation
HB-6.4
MCV -80.4
MCH-26.7
MCHC -31
TLC-10900
PLT -2.84

S.iron-45
S.ferritin -330.6

LFT-
Total Bilurubin- 0.51mg/dl
Direct Bilurubin-0.16 mg/dl
SGOT(AST)18 IU/L
SGPT(ALT)13 IU/L
ALKALINE PHOSPHATE176IU/L
TOTAL PROTEINS4.9 gm/dl
ALBUMIN2.3 gm/dl
A/G RATIO0.92

RFT 
UREA139 mg/dl
CREATININE7.3 mg/dl
URIC ACID4.9 mg/dl
CALCIUM8.5mg/dl
PHOSPHOROUS5.2 mg/dl
SODIUM136 mEq/L
POTASSIUM4.9 mEq/L
CHLORIDE106mEq/L

Anti HCV Antibodies - RAPIDNon Reactive HBsAg-RAPID Negative 

COMPLETE URINE EXAMINATION (CUE) ALBUMIN++
SUGAR+

2D ECHO
TRIVIAL TR WITH PAH, TRIVIAL AR, NO SCLEROTIC AV; MILD MR
NO AS/MS
EF 66%, GOOD LV FUNCTION
NO DIASTOLIC DYSFUNCTION
MILD CONCENTRIC LVH
MINIMAL PE, NO LV CLOT

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEKS
PRBC TRANSFUSED -0
ADMISSION IN ICU -1 ( due to PULMONARY ODEMA)


Treatment Given(Enter only Generic Name)
1.TAB NICARDIA 20MG PO TID
2.TAB TELMA 80 MG PO OD
3.TAB ARKAMINE 0.1 MG PO TID
4.TAB SHELCAL PO OD
5.TAB OROFER PO OD
6.TAB ZOFER 4MG PO TID
7. TAB. LASIX 80 MG PO BD
8.EPO 4000 IU SC BD
9.INJ IRON SUCROSE 100MG IN 100ML TWICE WEEKLY

Advice at Discharge
1.TAB NICARDIA 20MG PO TID
2.TAB TELMA 80 MG PO OD
3.TAB ARKAMINE 0.1 MG PO TID
4.TAB SHELCAL PO OD 5.TAB OROFER PO OD 6.TAB ZOFER 4MG PO TID 7. TAB. LASIX 80 MG PO BD 8.EPO 4000 IU SC BD
9.INJ IRON SUCROSE 100MG IN 100ML TWICE WEEKLY

Follow up at 3months 
HB -7.4
MCV -85.3
MCH -29.8
MCHC -32.1
TLC -9800
PLT -2.6


Follow up at the end of thesis 
HB -8.1
MCV -86.8
MCH -30.1
MCHC -30.9
TLC -7800
PLT -2.7

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