CASE 47

60year old male
DOA -5/3/2024
DOD -11/03/2024
CKD DURATION -4years and is on maintenance hemodialysis since 4months

DIAGNOSIS 
CHRONIC RENAL FAILURE 

Case History and Clinical Findings 
C/O B/L PEDAL EDEMA SINCE 3MONTHS C/O LOSS OF APPETITE SINCE 1MONTH


HOPI:PT WAS APPARENTLY ASYMPTOMATIC 3MONTHS BACK THEN DEVELOPED B/L PEDAL EDEMA WHICH IS INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE,PITTING TYPE OF EDEMA UPTO THE KNEES.
C/O LOSS OF APPETITE SINCE 1 MONTH NO H/O FEVER,NAUSEA,VOMITING
NO H/O ABDOMINAL PAIN,BURNING MICTURITION NO H/O INVOLUNTARY MICTURATION AND DEFECATION NO H/O INVOLUNTARY MOVEMENTS NO H/O SOB,ORTHOPNEA,PND NO H/O BLEEDING MANIFESTATION 

PAST HISTORY
K/C/O HTN SINCE 1 YEARS (NON COMPLIANT TO DRUGS) 
N/K/C/O DM,EPILEPSY,ASTHMA,CAD,CVA AND THYROID DISORDERS 

GENERAL EXAMINATION PALLOR PRESENT NO ICTERUS,CYANOSIS,CLUBBING
,LYMPHADENOPATHY OEDEMA OF FEET IS PRESENT 
TEMP-98.2 F
PR-88BPM
BP-150/80 MM HG
SPO2 98% @RA
CVS - S1S2 HEARD,NO MURMURS
RS - BAE PRESENT
P/A - SOFT ,NON TENDER NO ORGANOMEGALY
CNS - NFND

Investigation
HEMOGRAM
HB-4.7
TLC-5400
PCV-14.2
MCV-76.8
MCH-27.3
MCHC-33.1
RDW-CV:18.8
RDW-SD:56.9
RBC COUNT-1.72
PLATELET COUNT-1.4

SERUM IRON-54
SERUM FERRITIN -412.4

RBS-137MG/DL
BLOOD GROUP-B POSITIVE


CUE 
ALBUMIN +++
SUGAR NIL 

RFT 
UREA 242 mg/dl
CREATININE 13.2 mg/dl
URIC ACID 8.5 mg/dl
CALCIUM 8.7 mg/dl
PHOSPHOROUS5.9 mg/dl
SODIUM 137 mEq/L
POTASSIUM 5.8 mEq/L
CHLORIDE 103 mEq/L

LIVER FUNCTION TEST (LFT) 
Total Bilurubin 0.67 mg/dl
Direct Bilurubin 0.19 mg/dl
SGOT(AST) 28 IU/L
SGPT(ALT) 16IU/L
ALKALINE PHOSPHATASE 455 IU/L
TOTAL PROTEINS 7.3 gm/dl
ALBUMIN 4.4 gm/dl
A/G
RATIO 1.56

USG ABDOMEN AND PELVIS DONE ON 5/3/24
IMPRESSION:
-B/L GRADE-III RPD CHANGES

2D ECHO
TRIVIAL AR, TRIVIAL MR, TRIVIAL TR WITH PSH
EF 66%, GOOD LV FUNCTION
GRADE I DFIASTOLIC DYSFUNCTION
MILD CONCENTRIC LVH
NO RWMA, NO PE/ LV CLOT

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEK
PRBC TRANSFUSED -4
ADMISSION IN ICU -2 ( due to pulmonary odema)

Treatment Given(Enter only Generic Name)
FLUID RESTRICTION LESS THAN 1.5 L/DAY
SALT RESTRICTION LESS THAN 2-3 GM/DAY
TAB.LASIX 80 MG PO BD
INJ.EPO 4000 IU S/C ONCE A WEEK
INJ.IRON SUCROSE 100 MG IN 100 ML NS IV OD
TAB.NICARDIA 20 MG PO TID
TAB.TELMA 80 MG PO OD
TAB.OROFER-XT PO OD
 TAB.SHELCAL-CT PO OD
 TAB MET XL 25MG PO /OD

 Advice at Discharge
FLUID RESTRICTION LESS THAN 1.5 L/DAY SALT RESTRICTION LESS THAN 2-3 GM/DAY TAB.LASIX 80 MG PO BD
INJ.EPO 4000 IU S/C ONCE A WEEK 
INJ.IRON SUCROSE 100 MG IN 100 ML NS IV OD TAB.NICARDIA 20 MG PO TID
TAB.TELMA 80 MG PO OD
 TAB.OROFER-XT PO OD
 TAB.SHELCAL-CT PO OD 
TAB MET XL 25MG PO /OD

Follow up at 3months 
HB -6.0
MCV -78.3
MCH -28.1
MCHC -29.3
TLC -6900
PLT -2.15

Follow up at the end of thesis -patient has expired due to CVA 

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