case 36

75year old female 
DOA -8/4/2024
DOD -16/4/2024
CKD DURATION -not known

DIAGNOSIS 
CHRONIC KIDNEY FAILURE
S/P ABOVE KNEE AMPUTATION OF LEFTLOWERLIMB SECONDARY TO PVD 
ACUTE ANAL FISSURE
EXTERNAL HEMORRHOIDS GRADE 1 
K/C/O HTN SINCE 5 YEARS 

Case History and Clinical Findings 
C/O DECREASED URINE OUTPUT SINCE 2 DAYS.

HISTORY PRESENT ILLNESS :
PATIENT WAS APPARENTLY ASYMPTOMATIC 2 DAYS BACK THEN SHE DEVELOPED DECREASED URINE OUTPUT WHICH IS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE . NO H/O BURNING MICTURATION , NAUSEA , VOMMITING , FEVER , CONSTIPATION H/O ABDOMINAL DISTENSION SINCE 2 DAY


 H/O PAST ILLNESS :
K/C/O HTN SINCE 5 YEARS [ ON REGULAR MEDICATION ] N/K/C/O DM/CVD/CAD/ASTHMA/TB/THYROID H/O LT LEG AMPUTATION UPTO KNEE 1 MONTH BACK [PVD ] 

ON EXAMINATION :
PT IS C/C/C
NO PALLOR , ICTERUS , CLUBBING , CYANOSIS , LYMPHAEDNOPATHY
CVS : S1 , S2 + ; NO MURMURS
RS : BAE + , NVBS
CNS : NFND
P/A :ABDOMEN IS DISTENDED
ALL QUADRANTS OF ABDOMEN ARE MOVING SYMMETRICALLY MOVING WITH RESPIRATION
NO VISIBLE SCARS , SINUSES , PULSATIONS
NO VISIBLE MASS PRESENT
HERNIAL ORIFICE NORMAL , UMBILICUS IS CENTRAL AND INVERTED
NO SUPRA PUBIC BULGE PRESENT
ON PALPATION :
NO LOCAL RAISE OF TEMP , TENDERNESS PRESENT AT EPIGASTRIV REGION
ABDOMEN IS SOFT WITH NO GUARDING AND RIGIDITY
NO ORGANOMEGALY
PITTING EDEMA PRESENT OVER RIGHT LEG
ON ASCULTATION :
BOWEL SOUNDS PRESENT
REFERRALS -
OPHTHALMOLOGY 
IMPRESSION - NO DIABETIC OR HYPERTENSIVE RETINOPATHY CHANGES SEEN
SURGERY ;
ON 8/4/24
ADVICE - CONTINUE SAME TREATMENT AS PRIMARY PHYSICIAN
LEFT LOWER LIMB ELEVATION
REGULAR ASEPTIC DRESSINGS , REVIEW WITH REPEATS
ON 9/4/24 ;
HIGH FIBRE DIET
IN VIEW OF ANAL FISSURE THEY ADVICED
OINTMENT ANOBLISS FOR L/A
SITZ BATH WITH BETADINE TID
SYP CREMAFFIN 10 ML P/O H/S

INVESTIGATIONS 

RFT 
 UREA155 mg/dl
CREATININE6.5 mg/dl
URIC ACID15.7 mmol/L
CALCIUM10.0 mg/dl
PHOSPHOROUS6.1 mg/dl
SODIUM136 mmol/L
POTASSIUM4.0 mmol/L
CHLORIDE106 mmol/L

CUE
ALBUMIN++++
 mmol/L 

2 D ECHO : 
IMPRESSIN :
MILD MR + , MILD TR +[ ECCENTRIC TR + ] WITH PAH , TRIVIAL AR +
RWMA + ANTERIOR WALL MILD HYPO KINESIA , NVAS / MS
FAIR LV FUNCTIONS
DIASTOLIC DYSFUNCTIONS , NO LV CLOT

HEMOGRAM :
HB- 8.5 GM/DL
MCV -88.9
MCH-26.9
MCHC -27.6
TLC - 20,900 CELLS / CUMM
PLT - 2.63 LAKHS/CUMM


SMEAR -NORMOCYTIC NORMOCHROMIC 

S.IRON,-88
S.FERRITIN-168.5

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

Treatment Given(Enter only Generic Name) SALT RESTRICTION <2 G/ DAY
 FLUID RESTRICTION <1.5 L / DAY
 T.NICARDIA 10 MG PO/TID 
INJ LASIX 40 MG IV / BD 
T.NODOSIS 500 MG PO / BD
 T. SHELCAL - CT PO/
 T. OROFER - XT PO / OD
 OINT ANOBLISS L/A BD SITZ BATH WITH BETADINE TID 



Advice at Discharge
 T. NICARDIA 10 MG PO / TID
 T.LASIX 40 MG PO/ BD
 T.NODOSIS 500 MG PO / BD
 T.SHELCAL - CT PO/BD 
T.OROFER - XT PO / OD 
OINT ANOBLISS L/A BD
T.ECOSPIRIN -AV 75/10MG PO HS
 SITZ BATH WITH BETADINE TID

Follow up at 3months 
HB -9.0
MCV -89.4
MCH -28.7
MCHC -29.4
TLC -6300
Plt-2.86

Follow up at the end of thesis -patient has  lost to follow-up 

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