case 32

50year old female
DOA -17/11/2023
DOD -25/12/2023
CKD DURATION -2years and is on maintenance hemodialysis since 7months.


Diagnosis 
CKD ON MHD


Case History and Clinical Findings
PATIENT CAME WITH COMPLAINTS OF GENERALISED WEAKNESS SINCE ONE MONTH ,BILATERAL PEDAL EDEMAINSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE, PITTING TYPE, NO DIURNAL VARIATION SINCE 2 WEEKS,AND THEN DEVELOPED SHORTNESS OF BREATH INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE, GRADE 2, MMRC,NO PND, NO CHEST PAIN

 PAST HISTORY
 K/C/O DM TYPE 2 SINCE 3 YEARS
 K/C/O HTN
GENERAL EXAMINATION:
PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE,WELL ORIENTED TO TIME,PLACE AND PERSON.
BILATERAL PEDAL EDEMA PRESENT
NO PALLOR,ICTERUS CYANOSIS,CLUBING,LYMPHADENOPATHY
 VITALS:
TEMPERATURE:98.5 
BP:140/80 MM HG 
PR:78 BPM 
RR:18 CPM
SYSTEMIC EXAMINATION: 
CVS:S1,S2 HEARD NO MURMURS.
RS:BAE +,NVBS
CNS:NO FOCAL NEUROLOGICAL DEFICITS.
Investigation

 HB -9 gm/dl
MCV -87.3
MCH -30.1
MCHC -33.1
TLC -10400
PLATELET COUNT 5.10

S.iron-70
S.ferritin-302.1

CUE 

ALBUMIN+++
SUGAR+

LFT Bilurubin0.51 mg/dl
Direct Bilurubin0.20 mg/dl
SGOT(AST)11
IU/LSGPT(ALT)10 IU/L
ALKALINE PHOSPHATE227 IU/L
TOTAL PROTEINS7 gm/dl
ALBUMIN3.41gm/dl
A/G RATIO0.95

RFt

UREA112 mg/dl
CREATININE5 mg/dl
URIC ACID7.2mg/dl
CALCIUM 10.1 mg/dl
PHOSPHOROUS 5.7 mg/dl
SODIUM130mEq/L
POTASSIUM 6.1mEq/L
CHLORIDE98 mEq/L

2DECHO;
TRIVIAL TR PRESENT NO MR/AR
NO RWMA,NO AS/MS,SCLEROTIC AV
EF 60%, GOOD LV SYSTOLIC FUNCTION
GRADE 1 DIASTOLIC DYSFUNCTION ,NO PAH


USG OF ABDOMEN;
B/L GRADE 2 RPD CHANGES

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)
FLUID RESTRICTION< 1.5L/DAY
SALT RESTRICTION <2G/DAY
TAB.SHELCAL PO/OD
TAB.OROFER XT PO/OD
TAB LASIX 80 MG PO BD
TAB. TELMA 80 MG PO/OD
TAB. NICARDIA 20 MG PO/TID
Advice at Discharge
FLUID RESTRICTION< 1.5L/DAY
SALT RESTRICTION <2G/DAY
TAB.SHELCAL PO/OD TAB.OROFER XT PO/OD TAB LASIX 80 MG PO BD TAB. TELMA 80 MG PO/OD TAB. NICARDIA 20 MG PO/TID

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




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