case 48

40year old female 
DOA -1/11/2023
DOD -2/12/2023
CKD DURATION -6months and since then was on maintenance hemodialysis 


Diagnosis
 CKD ON MHD
Case History and Clinical Findings
C/O PEDAL EDEMA SINCE 6MONTHS,SOB SINCE 3 DAYS 

HOPI:
PATIENT WAS APPARANTLY ASYMPTOMATIC 6 MONTHS BACK THEN SHE DEVELOPED PEDAL EDEMA WHICH WAS PITTING TYPE,EXTENDING UPTO KNEE JOINT SINCE 3 DAYS.SHE DEVELOPED SHORTNESS OF BREATH WHICH WAS INSIDIOUS IN ONSET ,GRADUALLY PROGRESSIVE PROGRESSED FROM GRADE 2 TO GRADE 4 ,AGGREVATED ON EXERTION ,ORTHOPNEA + NO PND ,NO SEASONAL VARIATION ,NO DIURNAL VARIATION.DECREASED URINE OUTPUT SINCE 3 MONTHS.NO H/O FEVER ,COUGH,VOMITINGS ,LOOSE STOOLS,PAIN ABDOMEN ,GIDDINESS,CHESTPAIN ,PALPITAIONS,EXCESSIVE SWEATING 


Past history 
CKD ON MHD SINCE 6MONTHS
 K/C/O HTN SINCE 4 YRS
N/K/C/O CVA,THYROID ,ASTHMA,EPILEPSY O/E:
PT IS C/C/C
 PR:78
BP:150/80 MMHG
 RR:17
SPO2:98% ON RA 
CVS:S1 S2 + NO MURMURS 
RS:BAE+ NVBS
P/A:SOFT NON TENDER
CNS:NFND

Investigation
HB-6.4
MCV-80.5
MCH-26.7
MCHC-31
TLC -10900
PLT-2.34
SIRON -45
S.FERRITIN-330.6
SMEAR -NORMOCYTIC NORMOCHROMIC 

LFT-
Total Bilurubin0.51mg/dl
Direct Bilurubin0.16 mg/dl
SGOT(AST)18 IU/L
SGPT(ALT)13 IU/L
ALKALINE PHOSPHATE176IU/L
TOTAL PROTEINS4.9 gm/dl
ALBUMIN2.3 gm/dl
A/G RATIO0.92

RFT 
UREA139 mg/dl
CREATININE7.3 mg/dl
URIC ACID4.9 mg/dl
CALCIUM8.5mg/dl
PHOSPHOROUS5.2 mg/dl
SODIUM136 mEq/L
POTASSIUM4.9 mEq/L
CHLORIDE106

CUE

ALBUMIN++
SUGAR+
BILE

2D ECHO
TRIVIAL TR WITH PAH, TRIVIAL AR, NO SCLEROTIC AV; MILD MR
NO AS/MS
EF 54%, GOOD LV FUNCTION
GLOBAL HYPOKINESA 
MILD CONCENTRIC LVH
MINIMAL PE, NO LV CLOt 

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEK
PRBC TRANSFUSED -1
ADMISSION IN ICU -1 due to pulmonary odema 


Treatment Given(Enter only Generic Name)
1.TAB NICARDIA 20MG PO TID
2.TAB TELMA 80 MG PO OD
3.TAB ARKAMINE 0.1 MG PO TID
4.TAB SHELCAL PO OD
5.TAB OROFER PO OD
6.TAB ZOFER 4MG PO TID
7. TAB. LASIX 80 MG PO BD
8.EPO 4000 IU SC BD
9.INJ IRON SUCROSE 100MG IN 100ML TWICE WEEKLY

Advice at Discharge
1.TAB NICARDIA 20MG PO TID
2.TAB TELMA 80 MG PO OD
3.TAB ARKAMINE 0.1 MG PO TID
4.TAB SHELCAL PO OD 5.TAB OROFER PO OD 6.TAB ZOFER 4MG PO TID 7. TAB. LASIX 80 MG PO BD 8.EPO 4000 IU SC BD
9.INJ IRON SUCROSE 100MG IN 100ML TWICE WEEKLY

Follow up at 3months 
HB -7.4
MCV -87.9
MCH -29.8
MCHC -31.6
TLC -8700
Plt-2.54

Follow up at the end of thesis 
HB -8.1
MCV -89.9
MCH -30
MCHC -31.9
TLC -8500
PLT -2.7

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