case 29

55 year old male
DOA -6/2/24
DOD -14/2/24
CKD DURATION -5years and is on maintenance hemodialysis since 4months

Diagnosis
CHRONIC RENAL FAILURE SECONDARY TO ADPKD
 K/C/O HTN SINCE 10 YEARS 

Case History and Clinical Findings

 C/O LOWER LIMB SWELLING SINCE 2 MONTHS SOB SINCE 20 DAYS
PATIENT WAS APPARENTLY ASYMPTOMATIC 3 YEAR AGO THEN DEVELOPED PEDAL EDEMA INSIDIOUS ONSET GRADUALLY PROGRESSIVE PITTINBG TYPE RELIEVED WITH MEDICATION SINCE 2 MONTHS NOT IMPROVED WITH MEDICATION H/O BREATHLESSNESS SINCE 1 MONTH CLASS 3 NYHA ASSOCIATED WITH CHESTPAIN H/O RT SIDE LOIN PAIN NON RADIATING H/O ITCHING ALL OVER BODY NO H/O PALPITATIONS
NO H/O DECREASED URINE OUTPUT , BURNING MICTURITION NO H/O ORTHOPNEA , PND ,FEVER , COUGH , COLD 


PAST HISTORY : K/C/O HTN
N/K/C/O CAD , THYROID DISORDER , DM , TB ASTHMA , EPILEPSY N/K/C/O DM , HTN , CVA,THYROID ,TB ,EPILEPSY O/E:
PT IS C/C/C 
PR:86BPM 
BP:140/70MHG
RR:21
SPO2:98%@ RA
CVS:S1 S2 + NO MURMURS
RS:BAE+
FINE CREPTS PRESENT IN IAA, ISA
P/A:SOFT NON TENDER
CNS : NFND
Investigation

HB -8.3
MCV -80.3
MCH -26.9
MCHC -32.6
TLC -7900
PLT -2.1


S iron -54
S.ferritin -264.3

IMPRESSION-Normocytic normochromic Anemia

pH -7.20
PCO2 22.8
PO2 133
HCO3 8.7
St.HCO3 -16.4

BLOOD UREA - 98 mg/dl
SERUM CREATININE - 4.9 mg/dl
SODIUM 141 mEq/L
POTASSIUM 4.1 mEq/L
CHLORIDE 102 mEq/L
CALCIUM IONIZED -0.97 mmol/L


2D ECHOMODERATE CONCENTRIC LVH; TRIVIAL MR AND AR;NO MS/AS
GOOD LV SYSTOLIC FUNCTION, GRADE I DIASTOLIC DYSFUNCTION; EF 68%

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEK
PRBC TRANSFUSED -0
ADMISSION IN ICU -0


Treatment Given(Enter only Generic Name)
INJ IRON SUCROSE 100MG
INJ EPO 4000IU SC
TAB PAN 40 MG PO OD
.TAB LASIX 80 MG PO BD
.TAB NICARDIA 20 MG PO BD
.TAB OROFER XT PO OD
TAB TELMA 80 MG OD
.TAB SHELCAL PO OD
CAP BIO D3 PO/OD
FLUID RESTRICTION <1.5L/DAY SALT RESTICTION <2GM/DAY 

Advice at Discharge
 INJ IRON SUCROSE 100MG
 INJ EPO 4000IU SC
 TAB PAN 40 MG PO OD 
TAB LASIX 80 MG PO BD 
TAB NICARDIA 20 MG PO BD 
TAB OROFER XT PO OD 
TAB TELMA 80 MG OD 
TAB SHELCAL PO OD
 CAP BIO D3 PO/OD
FLUID RESTRICTION <1.5L/DAY SALT RESTICTION <2GM/DAY


Follow up at 3months 
HB -6.8
MCV -88.7
MCH -29.8
MCHC -30.1
TLC -5400
PLT -1.51

Follow up at the end of thesis 
HB -7.1
MCV -87.9
MCH -29.8
MCHC -29.8
TLC -6700
PLT -1.87

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