case 37

40year old male
DOA -2/4/2024
DOD -8/4/2024
CKD DURATION -1year

Diagnosis
CHRONIC RENAL FAILURE 
KNOWN CASE OF DIABETES
 KNOWN CASE OF HYPERTENSION 

 CHIEF COMPLAINT
C/O PEDAL EDEMA SINCE 5 DAYS . C/O SOB SINCE 5 DAYS .

HOPI
PATIENT WAS APPARENTLY ASYMPTOMATIC ONE YEAR BACK THEN HE DIAGNOSED WITH CKD AND ON CONSERVATIVE MANAGEMENT
C/O PEDAL EDEMA SINCE 5 DAYS B/L PITTING TYPE UPTO KNEE SOB SINCE 5 DAYS WHICH IS GRADE II RELEIVED BY TAKING REST .NO ORTHOPNEA , PND,NO NAUSEA AND VOMITING ,NO DECREASED URINE OUTPUT,NO CHEST PAIN ,NO PALPITATION , NO SWEATING, NO DECREASED APPETITE, NO FEVER,NO COUGH


 PAST HISTORY
K/C/O DM II SINCE 3 YEARS ON TAB GLIMIPERIDE 1MG PO/OD K/C/O HTN SINCE 1YEAR ON TAB AMLOKIND AT K/C/O CKD SINCE 1YEAR
TEMP 99F
PULSE 64BPM
BP 150/90MMHG
SPO2 98% ON RA
RR 18CPM
GRBS 119 MG%
SYSTEMIC EXAMINATION
CVS S1 S2 HEARD
RS NVBS HEARD
ABDOMEN : SOFT NON TENDER
NO NEUROLOGICAL DEFICIT FOUND

 Investigation

HB-9.4
MCV-83
MCH-28.2
MCHC-31.2
TLC-6700
PLT-2.12

S.IRON -72
S.FERRITIN-246.4

SMEAR -NORMOCYTIC NORMOCHROMIC 

 BLOOD UREA-175mg/dl
SERUM CREATININE -17.2 mg/dl
 SODIUM139 mmol/L
POTASSIUM4.6 mmol/L
CHLORIDE106 mmol/L

CUE
ALBUMIN++++
SUGARNil

ABG
 PH7.16
PCO2 -23.5
PO2- 44.2
HCO3 -8.1
St.HCO39.5
Sat79.2O2 

LIVER FUNCTION TEST -
 Total Bilurubin0.55mg/dl
Direct Bilurubin0.18 mg/dl
SGOT(AST)10 IU/L
SGPT(ALT)20 IU/L
ALKALINE PHOSPHATASE 228 IU/L
TOTAL PROTEINS5.5 gm/dl
ALBUMIN3.59 gm/dl
A/G RATIO1.88

2D ECHO -
EF -60%
GRADE 1 DIASTOLIC DYSFUNCTION 
LVH+


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)
FLUID RESTRICTION <1.5LIT PER DAY
SALT RESTRICTION <2GRAMS PER DAY
INJ.LASIX 40MG IV BD
INJ.HAI SC TID (4U-4U-4U)
INJ.EPO 4000IU SC WEEKLY ONCE
TAB.NICARDIA 20MG PO QID
TAB.TELMA 40MG PO OD
TAB.NODOSIS 500MG PO OD
TAB.SHELCAL CT PO OD
TAB.OROFER-XT PO OD
STRICT I/O CHARTING
GRBS 7. PROFILE
MONITOR VITALS 4TH HOURLY


Advice at Discharge
FLUID RESTRICTION <1.5LIT PER DAY
SALT RESTRICTION <2GRAMS PER DAY TAB.LASIX 40MG PO BD 
INJ.HAI SC TID (4U-4U-4U) 
INJ.EPO 4000IU SC WEEKLY ONCE TAB.NICARDIA 20MG PO QID
 TAB.TELMA 40MG PO OD 
TAB.NODOSIS 500MG PO OD 
TAB.SHELCAL CT PO OD
 TAB.OROFER-XT PO OD

Follow up at 3months -patient is continuing maintenance hemodialysis at other centre.

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