case 33

60 year old male 
DOA -6/2/2024
DOD -14/2/2024
CKD DURATION -5years and on maintenance hemodialysis since 6months 


Diagnosis 
CKD ON MHD
HYPERTENSION


Case History and Clinical Findings
 C/O GENERALISED SWELLING SINCE 1 WEEK

 HOPI
PATIENT WAS APPARENTLY ALRIGHT 1 WEEK BACK,THEN HE DEVELOPED GENERALISED SWELLING OF LOWER LIMBS ,UPPER LIMBS,ABDOMEN INSIDIOUS ONSET ,GRADUALLY PROGRESSIVE,PITTING TYPE H/O DECREASED URINE OUTPUT SINCE 10 DAYS H/O BREATHLESSNES CLASS III NYHA INSIDIOUS ONSET
H/O ITCHING ALL OVER BODY
 COUGH -PRODUCTIVE(MUCOID NON BLOOD STAINED, NON FOUL SMELLING)
H/O BURNING MICTURATION
NO H/O CHEST PAIN,VOMITING,FEVER,LOOSE STOOLS,PALPITATIONS 

PAST HISTORY
 K/C/O HTN SINCE 5 YEAR
NOT K/C/O DM,EPILEPSY,THYROID DISORDERS,CVA,ASTHAMA

 GENERAL EXAMINATION
PATIENT IS CONSCIOUS, COHERENT AND COOPERATIVE.
NO PALLOR,NO ICTERUS,NO CLUBBING,NO CYANOSIS,NO LYMPHADENOPATHY, OEDEMA IS PRESENT
TEMPERATURE-97.2F
PULSE RATE-84BPM
RR-19CPM
BP-140/100
SPO2-95%
SYSTEMIC EXAMINATION
CVS - S1 S2 HEARD NO MURMURS
RS - BAE+
PA - SOFT, NT
CNS - NO FND
Investigation
Hemogram 
HB-7.5
MCV -87.2
MCH -29.1
MCHC -35.1
TLC -8300
PLT-3.28

S.IRON-73
S.FERRITIN -298.3

RFT 
UREA -140
Creat-6.9
 SODIUM140 mEq/L
POTASSIUM3.8 mEq/L
CHLORIDE105 mEq/L
CALCIUM IONIZED1.16 mmol/L

USG
B/L GRADE II TO III RPD CHANGES
LEFT RENAL CORTICAL CYSTS

2D ECHO
EF: 63
MODERATE MR/AR/TR WITH PAH
NO RWMA NO AS/MS SCLEROTIC AV
DILATED RA AND RV
SEVERE CONCENTRIC LVH GOOD LV SYSTOLIC FUNCTIONS GRADE I DIASTOLIC DYSFUNCTION MINIMAL PE, NO LV CLOT

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) 1.TAB PAN 40 MG PO OD
 2.TAB LASIX 80MG PO BD 
3.TAB MET XL 25 MG PO OD
 4.TAB OROFER XT PO OD
 5.TAB SHELCAL PO OD
 6.TAB. TELMA 80 MG PO/OD
 7.TAB NICARDIA 20 MG PO TID 
8.INJ EPO 4000IU SC WEEKLY once 
9.INJ.IRON SUCROSE 1AMP IN 100ML NS IV ALTERNATIVE DAY

 Advice at Discharge 
1.TAB PAN 40 MG PO OD
 2.TAB LASIX 80MG PO BD
 3.TAB MET XL 25 MG PO OD
 4.TAB OROFER XT PO OD 
5.TAB SHELCAL PO OD
 6.TAB. TELMA 80 MG PO/OD
 7.TAB NICARDIA 20 MG PO TID 
8.INJ EPO 4000IU SC WEEKLY once 
9.INJ.IRON SUCROSE 1AMP IN 100ML NS IV ALTERNATIVE DAY

FOLLOW UP AT 3MONTHS 
PATIENT HAS EXPIRED DUE TO PULMONARY ODEMA.

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