case 30

77year old female
DOA -20/11/2023
DOD -29/11/2023
CKD DURATION -5months 
Diagnosis 
CHRONIC RENAL FAILURE 

Case History and Clinical Findings
PATIENT CAME WITH CHIEF COMPLAINTS OF ITCHING ALL OVER BODY SINCE 15DAYS
 C/O VOMITINGS SINCE 15 DAYS
PATIENT WAS APARENTLY ASYMPTOMATIC 15 DAYS BACK THEN DEVELOPED VOMITINGS,NON PROJECTILE,FOOD AND WATER IN CONTENT,NON BILIOUS,NOT ASSOCIATED WITH FEVER,CHILLS,COLD,COUGH WITH NO AGGREVATING AND RELIEVING FACTORS,
H/O ITCHING ALL OVER BODY
NO H/O PALPITATION CHEST PAIN,SWEATING NO H/O DYSPNEA,ORTHOPNEA,PND NO H/O BURNING MICTURATION 

PAST HISTORY:
K/C/O HTN SINCE 25YRS .
NOT A K/C/O DM,CAD,THYROID DISORDERS,EPILEPSY .

GENERAL EXAMINATION :
PT IS CONCIOUS , COHERENT AND COOPERATIVE , MODERATLY BUILT AND NOURISHED . NO PALLOR, ICTERUS , CYANOSIS, CLUBBING ,LYMPHADENOPATHY, EDEMA
 TEMP - AFEBRILE
 PR- 80BPM
 RR-18CPM
BP- 150/100MMHG 
GRBS - 147MG/DL
SYSTEMIC EXAMINATION :
CVS - S1,S2 HEARD , NO MURMURS
RS - NORMAL VESICULAR BREATH SOUNDS HEARD , NO WHEEZE AND DYSPNEA
P/A- SOFT , NON-TENDER , NO ORGANOMEGALY
CNS - NFND
DVL REFERRAL DONE:
DIAGNOSIS:SENILE XEROSIS
PRURITIS SECONDARY TO CKD STAGE 5
PRURITIS SECONDARY TO ANAEMIA
ADV:CEBHYDRA LOTION L/A BD X2WKS


Investigation

HB -6.9
MCV -84.8
MCH -28.8
MCHC -32.4
TLC -6400
PLT -2.7

SMEAR -NORMOCYTIC NORMOCHROMIC 
S.iron -25.7
S.ferritin-472.4

RFT 
UREA-250 mg/dl
CREATININE-8.3 mg/dl
URIC ACID-8.7 mg/dl
CALCIUM-10.1 mg/dl
PHOSPHOROUS-6.0 mg/dl
SODIUM-132 mEq/L
POTASSIUM-5.5 mEq/L
CHLORIDE-103 mEq/L


LIVER FUNCTION TESt
Total Bilurubin 0.56 mg/dl
Direct Bilurubin 0.19 mg/dl
SGOT(AST) 13 IU/L
SGPT(ALT) 8 IU/L
ALKALINE PHOSPHATE 194 IU/L
TOTAL PROTEINS 7.1 gm/dl
ALBUMIN 4.4 gm/dl
A/G RATIO 1.63


2D ECHO DONE;
IMPRESSION:MILD AR,MILD MR,TRIVIAL TR NO RWMA CONCENTRIC LVH,NO AS/MS GOOD LV SYSTOLIC FUNCTION
GRADE I DIASTOLIC DYSFUNCTION,NO LV CLOT  EF -64%

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEKS
PRBC TRANSFUSED -2
ADMISSION IN ICU -0


Treatment Given(Enter only Generic Name)
 T. LASIX 80 MG PO/BD 
T. NIFEDIPINE 20 MG PO/TID
 T. MVT PO/OD
INJ. IRON SUCROSE 100MG/ TWICE WEEKLY INJ. EPO 4000 IU SC/ ONCE WEEKLY 

Advice at Discharge
T. LASIX 80 MG PO/BD
 T. NIFEDIPINE 20 MG PO/TID
 T. MVT PO/OD
INJ. IRON SUCROSE 100MG/ TWICE WEEKLY INJ. EPO 4000 IU SC/ ONCE WEEKLY

Follow up at 3months 
HB -8.9
MCV -89.5
MCH -29.1
MCHC -30.1
TLC -9900
PLT -2.17

Follow up at the end of thesis -lost to follow up.

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