case 34

42year old female
DOA -13/6/2023
DOD -12/7/2023
CKD DURATION -4years and is on maintenance hemodialysis since 1.5 year.

DIAGNOSIS -
CHRONIC KIDNEY DISEASE ON MHD 
HYPERTENSION 
DIABETES MELLITUS TYPE 2

Case History and Clinical Findings 
PATIENT CAME WITH C/O SOBSINCE 10AYS GENERALIZED BODY SWELLING SINCE 2 MONTHS C/O FACIAL PUFFINESS SINCE 2 MONTHS C/O FEVER SINCE 2 MONTHS ON AND OFF.
HOPI
PATIENT WAS APPARENTLY ASYMPTOMATIC 2YRS AGO THEN SHE HAD DEVELOPED PEDAL EDEMA SINCE 2 MONTHS SHE HADH/O B/L PEDAL EDEMA SINCE 2 MONTHS LATER BECAME GENERALIZED BODY EDEMA AND FACIAL PUFFINESS ,FEVER LOW GRADE ,INTERMITTENT SINCE 2 MONTHS WITHOUT ANY DIURNAL VARIATION SOB GRADE 4
NO H/O NAUSEA ,VOMITINGS,FEVER
NO H/O CHEST PAIN PALPITATIONS SYNCOPAL ATTACKS ORTHOPANEA NO H/O COLD FEVER COUGH

 PAST HISTORY
K/C/O HTN SINCE 5 YRS
 K/C/O DM SINCE 7 YRS N/K/C/O ASTHMA, TB, CVD,CAD .

PERSONAL HISTORY
 APPETITE-NORMAL 
SLEEP-ADEQUATE
BOWEL AND BLADDER-REGULAR 
ADDICTIONS-NIL
GENERAL PHYSICAL EXAMINATION:
PATIENT IS CONSCIOUS, COHERENT AND COOPERATIVE
NO SIGNS OF PALLOR,ICTERUS, CLUBBING, LYMPHADENOPATHY, CYANOSIS.PEDAL
EDEMA
VITALS-
TEMP- 97.4 F
PR- 90BPM
RR18CPM
BP-170/90 MMHG
SPO2 99 AT RA
SYSTEMIC EXAMINATION:
CVS-S1S2 HEARD, NO MURMURS
RS-BAE PRESENT, NVBS
CNS-NAD
PA-SOFT, NON TENDER, NO ORGANOMEGALY

Investigation

CBC
HB 6.2
MCV -85.2
MCH-26.4
MCHC-30.8
TC 7900
PLT 2.22

SMEAR -NORMOCYTIC NORMOCHROMIC 

S iron -23
S.ferritin -402.3

RFT
CREAT 5.1
UREA 50
NA-136
K+ 3.3
CL-101

LFT
TB 0.75
DB 0.15
AST 8
ALT 5
ALP 122
TP 6.5
ALB 3.69

CUE
ALBUMIN ++
 SUGAR ++

2d ECHO -
EF -48% 
CONCENTRIC LVH 
GRADE 2 Diastolic dysfunction 

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEK
PRBC TRANSFUSED -2
ADMISSION IN ICU -4 (due to PULMONARY ODEMA)

Treatment Given(Enter only Generic Name)
 1) SALT RESTRICTION <2G/DAY 2)FLUIDRESTRICTION <1LT/DAY
3)INJ IRON SUCROSE 100MG IV ONCE WEEKLY 4)TAB NICARDIA 20MG PO/TID
 5)TAB TELMA 40MG PO /OD
 6)TAB SHELCAL CT 500MG PO/OD
 7)TAB OROFER XT PO/OD
 8)TAB LASIX 80MG PO/BD
 9)TAB MET XL 25MG PO/OD
10) INJ EPO 4000IU/SC/TWICE WEEEKLY

 Advice at Discharge
1) SALT RESTRICTION <2G/DAY 2)FLUIDRESTRICTION <1LT/DAY
3)INJ IRON SUCROSE 100MG IV ONCE WEEKLY 4)TAB NICARDIA 20MG PO/TID
 5)TAB TELMA 40MG PO /OD
 6)TAB SHELCAL CT 500MG PO/OD 
7)TAB OROFER XT PO/OD
 8)TAB LASIX 80MG PO/BD
 9)TAB MET XL 25MG PO/OD
10) INJ EPO 4000IU/SC/TWICE WEEEKLY

Follow up at 3months 
HB -7.6
MCV -80.5
MCH -29.7
MCHC -29.3
TLC -9400
PLT -3.76

Follow up at the end of thesis -
Patient has expired due to CVA.

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