case 27

58year old male
DOA - 28/1/2024
DOD -3/2/2024
CKD DURATION -4years and since 1month
And is on maintenance hemodialysis 


DIAGNOSIS 
STAGE V CHRONIC KIDNEY DISEASE

 Case History and Clinical Findings

 C/O SOB SINCE 1 DAY
DECREASEDSLEEP ,DECREASED APETITE SINCE 3 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THEN HE DEVELOPED DECREASE APETITE ,ABDOMINAL DISCOMFORT ,NAUSEASINCE 3 DAYS AGO NO VOMITINGS ,NO ABDOMINAL PAIN H/O DISTURBED SLEEP SINCE 3 DAYS SOB + GRADE II
H/O DECREASED URINE OUTPUT K/C/O DM SINCE 4 YRS

PAST HISTORY -

K/C/O CKD SINCE 4 YEAR ,ON CONSERVATIVE MANAGEMENT
 NOT A K/C/O HTN,,CVA ,ASTHMA ,EPILEPSY.


 O/E:
PT IS C/C/C 
PR:88BPM
BP:180/90 MMHG
 RR:17
SPO2:98% ON RA
CVS:S1 S2 + NO MURMURS
 RS:BAE+ NVBS
P/A:SOFT NON TENDER 

INVESTIGATIONS 
HB-8.0
MCV -87
MCH -29.4
MCHC -30.5
TLC -10500
PLT -1.71

S iron -72
S.ferritin-296

RFT 
UREA -197 mg/dl 
CREATININE 14.1 mg/dl 
URIC ACID 3.1 mg/dl 
CALCIUM 10.1 mg/dl
PHOSPHOROUS 6.1 mg/dl
 SODIUM 133 mEq/L 
POTASSIUM 4.1 mEq/L 
CHLORIDE 99 mEq/L

CUE -
ALBUMIN ++
SUGAR trace

 
LFT
Total Bilurubin  -0.56 mg/dl
Direct Bilurubin. -0.17 mg/dl
SGOT(AST) -11 IU/L
SGPT(ALT)-12 IU/L
ALKALINE PHOSPHATE110 IU/L
TOTAL PROTEINS-6.7 gm/dl
ALBUMIN-3.3 gm/dl
A/G RATIO-0.99


USG- B/L GRADE 3 RPD CHANGES 

2D ECHO
TRIVIAL AR, TRIVIAL MR, MILD TR WITH PAH EF 58%, GOOD LV FUNCTION NO DIASTOLIC DYSFUNCTION DILATED RA, DILATED LV NO 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 -0

Treatment Given(Enter only Generic Name) 1.FLUID RESTRICTION <1.5 L/ DAY 
2.SALT RESTRICTION <2 GM / DAY
3. TAB SHELLCAL CT PO /OD
 4.INJ EPO 400 IU S.C ONCE IN 2 WEEKLY 5.TAB LASIX 80 MG PO BD
6.INJ SUCROSE 200 MG IN 100 ML NS IV /ONCE IN 2 WEEKS 
7.TAB NICARDIA 20 MG PO/TID

 Advice at Discharge
1.FLUID RESTRICTION <1.5 L/ DAY
 2.SALT RESTRICTION <2 GM / DAY 
3. TAB SHELLCAL CT PO /OD
 4.INJ EPO 400 IU S.C ONCE IN 2 WEEKLY 5.TAB LASIX 80 MG PO BD
6.INJ SUCROSE 200 MG IN 100 ML IV /ONCE IN 2 WEEKS 
7.TAB NICARDIA 20 MG PO/TID


 Follow Up at 3months 
HB -9.2
MCV -89.4
MCH -28.3
MCHC -30.2
TLC -6700
PLT -1.89


Follow up at the end of thesis 
Patient has expired due to pulmonary odema 

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