CASE 40

46year old male
DOA -4/11/2023
DOD -4/12/2024
CKD DURATION -not known 
On maintenance hemodialysis since 1year

Diagnosis
CKD ON MHD
DIABETES MELLITUS SINCE 10YEARS
HYPERTENSION 

Case History and Clinical Findings
 PATIENT CAME WITH C/O SOB SINCE 3 DAYS
C/O GENERALIZED BODY SWELLING SINE 20 DAYS PT WAS APPARENTLY ASYMPTOMATIC 30 DAYS AGO,
C/O GENERALISED BODY SWELLING TILL KNEES INITIALLY, THEN GRADUALLY PROGRESSED TO THE WHOLE BODY SINCE 20 DAYS C/O SOB MORE ON EXERTION SINCE 3 DAYS.

PAST HISTORY
K/c/o CAD 
K/C/O DM TYPE-2 SINCE 10 YEARS
K/C/O HTN SINCE 5 MONTHS ON 
TAB. NICARDIA 20MG/OD .
NOT A K/C/O THYROID, ASTHMA, EPILEPSY, TB 

Investigation
LFT -
Total Bilurubin0.59 mg/dl
Direct Bilurubin0.21 mg/dl
SGOT(AST)20 IU/L
SGPT(ALT)17 IU/L
ALKALINE PHOSPHATE151 IU/L
TOTAL PROTEINS6.2 gm/dl
ALBUMIN2.8 gm/dl
A/G RATIO0.83


RFT
UREA -80 mg/dl
CREATININE6.2 mg/dl
URIC ACID6.4 mg/dl
CALCIUM10.0 mg/dl
PHOSPHOROUS3.8 mg/dl
SODIUM132 mEq/L
POTASSIUM4.4 mEq/L
CHLORIDE101 mEq/L


CUE -

ALBUMIN +
SUGAR+

 
2D ECHO
MILD AR, MODERATE MR, TRIVIAL AR
MODERATE CONCENTRIC LVH
DILATED LA AND LV
EF 43%, MODERATE LV DYSFUNCTION
RWMA+, LAD,RCA AND LCx HYPOKINESIA
GRADE I DIASTOLIC DYSFUNCTION
NO PE, NO LV CLOT

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -1
ADMISSION IN ICU -0

Treatment Given(Enter only Generic Name)
SALT RESTRICTION <2GM/DAY
FLUID RESTRICTION <1.5 LTR /DAY
TAB OROFER XT PO OD
TAB NICARDIA 20MG PO TID
TAB TELMA 80 MG PO/OD
TAB LASIX 80 MG PO BD
TAB MET XL 25 MG PO BD
INJ EPO 4000 IU SC 1 X WEEKLY
INJ IRON SUCROSE IN 100ML NS IV ONCE WEEKLY

Advice at Discharge
SALT RESTRICTION <2GM/DAY
FLUID RESTRICTION <1.5 LTR /DAY
TAB OROFER XT PO OD
TAB NICARDIA 20MG PO TID
 TAB TELMA 80 MG PO/OD
 TAB LASIX 80 MG PO BD
 TAB MET XL 25 MG PO BD 
INJ EPO 4000 IU SC 1 X WEEKLY
INJ IRON SUCROSE IN 100ML NS IV ONCE WEEKLY

Follow up at 3months 
HB -8.0
MCV -79.8
MCH -29.7
MCHC -30.1
TLC -6700
PLT -1.87

Follow up at end of thesis 
HB -7.9
MCV -78.2
MCH -30.1
MCHC -29.5
TLC -7300
PLT -2.1


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