case 26

55year old male
DOA -7/8/2024
DOD-17/8/2024
CKD DURATION -5 years and since then has been on maintenance hemodialysis.


Diagnosis
CKD ON MHD WITH DM SINCE 10 YEARS AND HTN SINCE 15 YEARS

CHIEF COMPLAINTS

C/O B/L PEDAL EDEMA SINCE 2MONTHS C/O DECREASED APPETITE SINCE 2 MONTHS HOPIPATIENT WAS APPARENTLY ASYMPTOMATIC 2 MONTHS BACK AND DEVELOPED B/L PEDAL EDEMA UPTO KNEES PITTING TYPE ASSOCIATED WITH DECREASED URINE OUTPUT.C/O DECREASEDAPPETITE SINCE 2 MONTHS NO C/O FEVER COUGH COLD.


 PAST HISTORY
K/C/O DM SINCE 10 YEARS
 K/C/O HTN SINCE 15 YEARS 
K/CO CKD SINCE 5 YEARS 
N/K/C/O TB EPILEPSY CVA 

GENERAL EXAMINATION
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY PITTING TYPE OF PEDAL EDEMA
 TEMP- AFEBRILE 
RR 16 CPM
BP-150/90 MM HG
 PR 71BPM
SPO2 98% @RA
CVS - S1S2 HEARD,NO MURMURS
RS - BAE PRESENT
P/A - SOFT ,NON TENDER NO ORGANOMEGALY
CNS - NFND


Investigation
CUE
ALBUMIN -++++
SUGAR +++


RFT
BLOOD UREA -77 mg/dl
SERUM CREATININE 7.1 mg/dl
SODIUM 132 mmol/L
POTASSIUM 4.0 mmol/L
CHLORIDE101 mmol/L
CALCIUM IONIZED 9.4 MMOL/L


HAEMOGLOBIN 8.2gm/dl
TOTAL COUNT 8,200 
 M C V 82.7 fl 
M CH -28.4 pG
M C H C 34.3 % 
PLATELET COUNT 4.4 lakhs/cu.mm

S IRON -61.3
S.FERRITIN-312.6

 SMEAR Normocytic normochromic WBC With in normal limits
PLATELETS Adeqaute HEMOPARASITES No hemoparasites seen
IMPRESSION Normocytic
normochromic blood
RBS 109 MG/DL
USG IMPRESSIONS : RIGHT GRADE II RPD CHANGES
LEFT GRADE II RPD CHANGES

2D ECHO:
MILD CONCENTRIC LVH
GOOD LV SYSTOLIC FUNCTION
GRADE I DIASTOLIC DYSFUNCTION
NO RWMA
NO PE; EF 68%
MILD AR, MILD MR, MODERATE TR WITH MILD PAH
NO LV CLOT

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -1
ADMISSION IN ICU -1( due to pulmonary odema)

Treatment Given(Enter only Generic Name) SALT RESTRICTION <2G/DAY 
FLUID RESTRICTION <1.5L/DAY
 INJ EPO 4000 IV S/C ONCE IN 2 WEEKS
 TAB MVT PO/OD X 5 DAYS
 TAB TELMA 80MG PO/OD X 5 DAYS
 TAB NICARDIA 20MG PO/TID X 5 DAYS
 TAB LASIX 80MG PO/BD X 5 DAYS 
TAB MET XL 25 MG PO/OD X 5 DAYS
 TAB SHELCAL CT PO/OD X 5 DAYS 
INJ IRON SUCROSE 100MG IV/ ONCE IN 2 WEEK 

Advice at Discharge
 SALT RESTRICTION <2G/DAY 
FLUID RESTRICTION <1.5L/DAY
 INJ EPO 4000 IV S/C ONCE IN 2 WEEKS 
TAB MVT PO/OD X 5 DAYS
 TAB TELMA 80MG PO/OD X 5 DAYS
 TAB NICARDIA 20MG PO/TID X 5 DAYS
 TAB LASIX 80MG PO/BD X 5 DAYS 
TAB MET XL 25 MG PO/OD X 5 DAYS 
TAB SHELCAL CT PO/OD X 5 DAYS
 INJ. IRON SUCROSE 100MG IV/ ONCE IN 2 WEEK

FOLLOW UP AT 3MONTHS 
HB-9.5
MCV -88.7
MCH -29.6
MCHC -29.9
TLC -9800
PLT -3.75

Follow up at the end of thesis 
HB -10
MCV -89.6
MCH -30.1
MCHC -29.5
TLC -6500
PLT -4.0

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