case 31

66year old male
DOA -26/02/2024
DOD -04/02/2024
CKD DURATION - 5YEARS and is maintenance hemodialysis since 3months

Diagnosis 
HYPOGLYCEMIA 
CHRONIC RENAL FAILURE
ANAEMISECONDARY TO CKD
 DM TYPE 2,HTN

Case History and Clinical Findings
 ALTERED SENSORIUM SINCE 3 HRS

HOPI 
PATIENT WAS BROUGHT TO CASUALITY IN A ALTERED SENSORIUM STATE.
H/O pedal odema since 2years on and off 
H/o decreased urine output since 1week
H/o shortness of breath since 1year grade 2 -3
 NO H/O INVOLUNTARY MICTURATION AND DEFECATION NO H/O INVOLUNTARY MOVEMENTS. NO H/O VOMITING,DIARRHEA NO H/O ABDOMINAL PAIN.

 PAST HISTORY
K/C/O CKD SINCE 5 YRS
K/C/O DIABETES SINCE 20 YRS ON INJ.MIXTARD 25-- 0 --20 K/C/O 
HTN SINCE 20 YEARS ON TELMA-40

 GENERAL EXAMINATION
NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY OEDEMA OF FEET IS PRESENT TEMP-98F
RR 20 CPM
BP-160/90 MM HG
SPO2 98% @RA
GRBS - 45 MG% AFTER 25 D --- 197 MG/DL
CVS - S1S2 HEARD,NO MURMURS
RS - BAE PRESENT
P/A - SOFT ,NON TENDER NO ORGANOMEGALY
CNS - NFND

Investigation
HB-9.0
MCV -79.8
MCH -27.5
MCHC -30.2
TLC-11700
PLT-2.45

S.iron- 56
S.ferritin -348.7


CUE 
ALBUMIN +++
SUGAR Nil

RFT
UREA 129 mg/dl
CREATININE 6.9 mg/dl
URIC ACID 6.6 mg/dl
CALCIUM 10.0 mg/dl
PHOSPHOROUS 4.4 mg/dl
SODIUM 138 mEq/L
POTASSIUM 3.4 mEq/L
CHLORIDE 103 mEq/L

LIVER FUNCTION TEST (LFT) 
Total Bilurubin 0.53 mg/dl
Direct Bilurubin 0.18 mg/dl
SGOT(AST) 24 IU/L
SGPT(ALT) 22 IU/L
ALKALINE PHOSPHATASE 207 IU/L
TOTAL PROTEINS 6.3 gm/dl
ALBUMIN 3.24 gm/dl
A/G RATIO 1.06

2D ECHO:
NO RWMA,CONCENTRIC LVH +
MODERATE MR +,NO MS,MILD MAC +
MODERATE AR +,NO AS,SCLEROTIC AV
MODERATE TR + WITH MILD PAH
EF=58% GOOD LV SYSTOLIC FUNCTION
GRADE 2 DIASTOLIC DYSFUNCTION + MINIMAL PE +
IVC SIZE-1.10 CMS COLLAPSING DILATED LA/LV
RVSP 42+10=52 MM HG 

USG- ABDOMEN AND PELVIS : B/L GRADE 3 RPD CHANGES

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) FLUID RESTRICTION LESS THAN 1.5 L/DAY SALT RESTRICTION LESS THAN 2-3 GM/DAY TAB .LASIX 80 MG PO BD
 TAB.NICARDIA 20 MG PO TID 
TAB.OROFER-XT PO OD
 TAB.SHELCAL-CT PO OD
 INJ.EPO 4000 IU S/C ONCE 2 WEEK
 INJ.IRON SUCROSE 200 MG IN 100 ML NS IV OD 


Advice at Discharge
FLUID RESTRICTION LESS THAN 1.5 L/DAY SALT RESTRICTION LESS THAN 2-3 GM/DAY TAB .LASIX 80 MG PO BD
 TAB.NICARDIA 20 MG PO TID 
TAB.OROFER-XT PO OD
 TAB.SHELCAL-CT PO OD 
INJ.EPO 4000 IU S/C ONCE 2 WEEK
 INJ.IRON SUCROSE 200 MG IN 100 ML NS IV OD


Follow up at 3months -patient has expired due to pulmonary odema 

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