case 41

75 year old male
DOA - 27/08/2024
DOD -2/9/2024
CKD DURATION -1 year and is on maintenance hemodialysis since 7months 

DIAGNOSIS 
  CKD (STAGE -V)
HFeEF 
PAROXYSMAL ATRIAL FIBRILLATION REFRACTORY HYPERKALEMIA(RESOLVED)

 Case History and Clinical Findings
C/O DECREASED URINE OUTPUT SINCE 20days 
BREATHLESSNESS SINCE 1 DAY,
 PEDAL EDEMA SINCE 1 YEAR

 HOPI:
THE PATIENT WAS APPARENTLY ASYMPTOMATIC 1 YEAR AGO THEN HE DEVELOPED PEDAL EDEMA PITTING TYPE EXTENDING UPTO BELOW KNEE, DIAGNOSED AS CKD ON CONSERVATIVE MANAGEMENT
H/O DECREASED URINE OUTPUT SINCE 20 DAYS
H/O BREATHLESSNESS GRADE II-III MRRC, AGGRAVATED IN LYING DOWN POSITION, RELIEVED IN SUPINE POSITION, ORTHOPNEA+ NO H/O CHEST PAIN, PALPITATIONS
NO H/O PAIN ABDOMEN, VOMITING, LOOSE STOOLS 

PAST HISTORY:
K/C/O CKD SINCE 1 YEAR ON CONSERVATIVE TREATMENT 
NOT A K/C/O DM/HTN/CAD/CVA/ASTHMA/THYROID/SEIZURE DISORDERS


PERSONAL HISTORY
APPETITE - NORMAL
DIET - MIXED
BOWEL AND BLADDER - REGULAR
NO KNOWN ALLERGIES AND ADDICTIONS
GENERAL EXAMINATION :
PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE.
NO SIGNS OF PALLOR,ICTERUS,CYNOSIS,CLUBBING,LYMPHADENOPATHY,OEDEMA OF
FOOT
TEMP: 98.2F
BP:130/90 MMHG
RR: 18 CPM
PR: 102 BPM
SPO2 98% AT RA
GRBS: 105 MG%
SYSTEMIC EXAMINATION:
CVS: S1S2 HEARD. NO MURMURS.
RS: BAE+. TRACHEA- CENTRAL.
P/A: SOFT,NON-TENDER.
CNS: NFND
INVESTIGATIONS 
HB-12.8
MCV -89.1
MCH -31.6
MCHC -35.4
TLC -12000
PLT -1.5

S.iron -57
S.ferritin -283.7

SMEAR -NORMOCYTIC NORMOCHROMIC 



CUE
 ALBUMIN ++++
SUGAR Nil 

LFT
TOTAL Bilurubin 1.47 mg/dl
Direct Bilurubin 0.78mg/dl
SGOT(AST) 35 IU/L
SGPT(ALT) 28 IU/L
ALKALINE PHOSPHATASE 253 IU/L
TOTALPROTEINS 5.7 gm/dl
ALBUMIN 3.09 gm/dl
A/G RATIO 1.18

RFT
UREA 123 mg/dl
CREATININE 4.3 mg/dl
URIC ACID 6.4 mmol/L
CALCIUM 8.4 mg/dl
PHOSPHOROUS 4.6 mg/dl
SODIUM 126 mmol/L
POTASSIUM 6.3 mmol/L.
CHLORIDE 95 mmol/L 


2D ECHO -EF -57% CONCENTRIC LVH 
GRADE 1 DIASTOLIC DYSFUNCTION 

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 
SALT RESTRICTION LESS THAN 2GM /DAY
TAB.NODOSIS 500 MG TID 
TAB.SHELCAL-CT PO/OD 
TAB OROFER-XT PO/OD 
TAB.MET-XL 25 MG PO/BD
 TAB.PCM 650 MG PO/TID
INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD ALTERNATE DAY 
INJ EPO 4000IU SC WEEKLY ONCE 


Advice at Discharge 
TAB.TAXIM 200MG PO/BD 
TAB.NODOSIS 500 MG TID 
TAB.SHELCAL-CT PO/OD 
TAB OROFER-XT PO/OD 
TAB.MET-XL 25 MG PO/BD
 TAB.PCM 650 MG PO/TID
INJ.IRON SUCROSE 1AMP IN 100ML NS IV OD ALTERNATE DAY 
INJ EPO 4000IU SC WEEKLY ONCE 


Follow up -patient has expired possibility due to ?hyperkalemia? Atrial fibrillation.

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