CASE 46

64year old male
DOA -10/5/2024
DOD -21/5/2024
CKD DURATION -2months and since then was on maintenance hemodialysis 

Diagnosis 
CKD ON MHD 
DIABETIS MELLITUS 
HYPERTENSION 

Case History and Clinical Findings C/O SOB SINCE 3 MONTHS

HOPI 
PATIENT WAS AP[PARENTLY ASYMOTOMATIC 3 MONTHS AGO THEN HE DEVELOPE SOB OF GRADE 2 TO 3 NOT ASSOCIAED WITH COUGH PALPITATION CHEST PAN PROFUSE SWEATING
NO H/O DECREASED URINE OUTPUT H/O NSAID ABUSE +
NO H/O HEMATURIA,PYURIA,CHYLURIA

 PAST ILLNES
H/O HTN SINCE 2 YEARS
H/O DM2 SINCE 10 YEARS ON REGULAR MEDICATIONS N/K/C/O CVA CAD TB EPILEPSY .

 GENERAL EXAMINATION: ON EXAMINATION PALLOR-PRESENT
NO CYANOSIS CLUBBING ICTERUS LYMPHADENOPATHY OEDEMA 
VITALS:
TEMP:98F
 PR-90/MIN
RR-20/MIN
BP-130/80 MMHG
SPO2-98%
SYSTEMIC EXAMINATION:
CNS-NFND
CVS-NO THRILLS,NO MURMURS,S1S2 HEARD
RS-DYSPNOEA IS PRESENT
NO WHEEZE
TRACHEA -CENTRAL
P/A-SOFT NT

Investigation
CBP
HB- 8GM/DL
MCV -85.4
MCH -29.4
MCHC -32.9
TC- 11000CELLS/CUMM
PLT - 2.9L

S IRON-49
S.FERRITIN-287
SMEAR -NORMOCYTIC NORMOCHROMIC 

BLOOD UREA :137 mg/dl
SERUM CREATININE : 7.8 mg/dl
SR NA- 136 mmol/L
SR K- 3.9
SR CL - 106

2d ECHO 
EF -60% 
GRADE 1 diastolic dysfunction 


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

Treatment Given(Enter only Generic Name)
1]FLUID RESTRICTION LESS THAN 2 LI/DAY
2]SALT RESTRICTION LES THAN 2 GM/DAY
3]TAB.NODOSIS 500MG PO/BD
4]T.LASIX 40 MG PO/BD
5]TAB.OROFE XT PO/OD
6]TAB SHELCAL CT PO/OD
7]CAP BIO-D3 PO/ONCE A WEEK
8]GRBS 7 POINT PROFILE 9]
TAB.NICARDIA 5MG PO/OD 10]
MONITOR VITALS 4TH HOURLY 
INJ.EPO 4000IU SC WEEKLY ONCE 
INJ IRON SUCROSE 1AMP IN 100ML NS IV OD ON ALTERNATE DAY 

Advice at Discharge
1]FLUID RESTRICTION LESS THAN 2 LI/DAY 2]SALT RESTRICTION LES THAN 2 GM/DAY 
3]TAB.NODOSIS 500MG PO/OD
 4]T.LASIX 40 MG PO/BD 
5]TAB.OROFER XT PO/OD
6]TAB SHELCAL CT PO/OD 
7.TAB.NICARDIA 10MG PO/OD
8.]CONTINUE SAME TREATMENT FOR DIABETES
INJ.EPO 4000IU SC WEEKLY ONCE 
INJ IRON SUCROSE 1AMP IN 100ML NS IV OD ON ALTERNATE DAY 

FOLLOW UP AT 3MONTHS 
HB-7.5
MCV-88.7
MCH-30.1
MCHC -31.1
TLC -8900
PLT-2.7

FOLLOW UP AT THE END OF THESIS 
HB-8.2
MCV-89.7
MCH-31.6
MCHC-31.9
TLC -9000
PLT-2.87

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