CASE 45

58 year old male 
DOA -26/08/2024
DOD -23/09/24
CKD DURATION -not known 
On maintenance hemodialysis since 8months 

DIAGNOSIS 
CKD ON MHD
HYPERTENSION 

CHEIF COMPLAINTS :
C/O PEDAL EDEMA SINCE 1 MONTH C/O SOB SINCE 1 MONTH

HOPI:
PATIENT WAS APPARENTLY ALRIGHT 1 MONTH BACK THE HE HAD PEDAL EDEMA SINCE 1 MONTH WHICH IS PITTING TYPE TILL KNEE.
SOB SINCE 1 MONTH MMRC GRADE-2, RELIVED BY TAKING REST. NO ORTHOPNEA NO PND
PAST HISTORY:
K/C/O HTN 
N/K/C/O , DM, CAD, CVA, SEIZURES.

PERSONAL HISTORY
 APPETITE - NORMAL 
DIET - MIXED
BOWEL AND BLADDER - REGULAR 
NO KNOWN ALLERGIES
ADDICTIONS- NONE

GENERAL EXAMINATION :
PALLOR PRESENT, PEDAL EDEMA PRESENT
CLUBBING OF FINGURE PRESENT
NO SIGNS OF ICTERUS,CYNOSIS,LYMPHADENOPATHY
TEMP: 97.8F
BP:130/80 MMHG
RR: 18 CPM
PR: 97BPM
SPO2 98 AT RA
SYSTEMIC EXAMINATION:
CVS: S1S2 HEARD. NO MURMURS.
RS: BAE+. TRACHEA- CENTRAL, B/L BASAL CREPTS PRESENT
P/A: SOFT,NON-TENDER.
CNS: NFND

Investigation
HB -9.5
MCV -87.8
MCH -31.3
MCHC -35.6
TLC 11800
PLT -1.2
SMEAR -NORMOCYTIC NORMOCHROMIC 
S iron -40
S ferritin -180.8

LFT 
Total Bilurubin 0.59 mg/dl
Direct Bilurubin 0.27mg/dl
SGOT(AST) 12 IU/L
SGPT(ALT) 19 IU/L
ALKALINE PHOSPHATASE 162 IU/LTOTAL
PROTEINS 6.1 gm/dl
ALBUMIN 3.3 gm/dl
A/G RATIO 1.20


RFT 
UREA 144 mg/dl
CREATININE 7.4 mg/dl
URIC ACID 6.9 mmol/L
CALCIUM 8.9 mg/dl
PHOSPHOROUS 5.3 mg/dl
SODIUM 133 mmol/L
POTASSIUM 5.3 mmol/L
CHLORIDE 97mmol/L

CUE 
ALBUMIN ++
SUGAR Nil

2D ECHO 
EF 54% 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 -1 (due to CVA)

Treatment Given(Enter only Generic Name)
1.FLUID RESTRICTION<1.5LIT/DAY
2.SALT RESTRICTION<2G/DAY
3.TAB NODOSIS 500MG PO/BD
4.TAB SHELCAL CT PO/OD
5.TAB LASIX 40 MG POX OD
6.TAB OROFER XT PO/OD
7.INJ EPO 4000 IV SC/TWICE WEEKLY
8. TAB TELMA 40 MG PO/OD

Advice at Discharge
1.FLUID RESTRICTION<1.5LIT/DAY 
2.SALT RESTRICTION<2G/DAY 
3.TAB NODOSIS 500MG PO/BD
 4.TAB SHELCAL CT PO/OD 
5.TAB LASIX 40 MG POX OD
 6.TAB OROFER XT PO/OD
7.INJ EPO 4000 IV SC/TWICE WEEKLY
 8. TAB TELMA 40 MG PO/OD 

Follow up at 3months 
HB -9.8
MCV-88.3
MCH-30.2
MCHC-31.6
TLC -8000
PLT -2.0

FOLLOW UP AT THE END OF THESIS - PATIENT HAS EXPIRED DUE TO CVA 

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