case 50

65 year old male
DOA -27/08/2024
DOD -2/9/2024
CKd DURATION -not known

DIAGNOSIS 
UREMIC ENCEPHALOPATHY 
  CHRONIC RENAL FAILURE WITH REFRACTORY HYPERKALEMIA 
PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
 HEART FAILURE WITH MID- RANGE EJECTION FRACTION 

 Clinical Findings
 C/O BREATHLESSNESS SINCE 2 DAYS

 HOPI:
THE PATIENT WAS APPARENTLY ASYMPTOMATIC 1MONTH BACK THEN HAD PEDAL ODEMA ON AND OFF PITTING TYPE BREATHLESSNESS SINCE 2 DAYS, GRADE 3-4 MMRC, NOT RELIIEVED AT REST N/H/O CHEST PAIN, PALPITATIONS, ORTHOPNEA, PND N/H/O PAIN.ABDOMEN, VOMITING, LOOSE STOOLS

 PAST HISTORY:
K/C/O FILARIASIS SINCE 5 YRS 
K/C/O HTN SINCE 6 MONTHS ON UNKNOWN MEDICATIONS


PERSONAL HISTORY
 APPETITE - NORMAL
DIET - MIXED
BOWEL AND BLADDER - REGULAR
NO KNOWN ALLERGIES AND ADDICTIONS
GENERAL EXAMINATION :
PAITIENT IS CONSCIOUS,COHERENT,COOPERATIVE.
NO SGNS OF PALLOR,ICTERUS,CYNOSIS,CLUBBING,LYMPHADENOPATHY,OEDEMA OF
FOOT
TEMP: 98.2F
BP:90/60MMHG
RR: 30 CPM
PR: 202 BPM
SPO2 98% AT RA
GRBS: 132 MG%
SYSTEMIC EXAMINATION:
CVS: S1S2 HEARD. NO MURMURS.
RS: BAE+. TRACHEA- CENTRAL.
CREPTS PRESENT IN LEFT IAA,MA
P/A: SOFT, NON TENDER
CNS: NFND
Investigation
HEMOGRAM
HAEMOGLOBIN 9.9gm/dl
TOTAL COUNT 13000 cells/cumm
PCV:28.5
MCV:80.5
MCH:27.5
MCHC:34.4
RBC COUNT:3.60
PLATELET COUNT:1.45

SIRON -45
S ferritin -216

RFT 
UREA 215 mg/dl
CREATININE 5.3 mg/dl
URIC ACID 9.0 mmol/L
CALCIUM 9.2 mg/dl
PHOSPHOROUS 6.4 mg/dl
SODIUM 144 mmol/L
POTASSIUM 6.0 mmol/L.
CHLORIDE 104 mmol/L


LFT-
Total Bilurubin 1.09 mg/dl
Direct Bilurubin 0.24 mg/dl
SGOT(AST) 94 IU/L
SGPT(ALT) 20 IU/L
ALKALINE PHOSPHATASE 254 IU/L
TOTAL PROTEINS 6.0 gm/dl
ALBUMIN 2.3 gm/dl
A/G RATIO 0.62


CUE- 
ALBUMIN +++
 SUGAR Nil
 
RFT 
UREA 177 mg/dl
CREATININE 4.7 mg/dl
URIC ACID 8.0 mmol/L
CALCIUM 10.0 mg/dl
PHOSPHOROUS 5.7 mg/dl
SODIUM 145 mmol/L
POTASSIUM 6.1 mmol/L
CHLORIDE 106 


USG DONE IMPRESSION:
RIGHT GRADE I AND LEFT GRADE II RPD CHANGES B/L REANAL CYSTS
GALLBLADDER SLUDGE/MICROLITHS RIGHT MINIMAL PLEURAL EFFUSIONS .

2D ECHO DONE ON 28/8/24 TACHYCARDIA DURING STUDY GLOBAL HYPOKINESIA AND MILD LVH MILD TR WITH PAH(RVSP2 30HO2 MMHG) TRIVIAL AR ;TRIVIAL MR MAC;SCLEROTIC AV;NO AS/MS IAS-INFRACT OR ANEURYSM EF2 51% FAIR LV SYSTOLIC FUNCTION GRADE 1 DIASTOLIC DYSFUNCTION IVC SIZE 0.4CMS,COLLAPSING NO PE/LV CLOT

Treatment Given(Enter only Generic Name) IV FLUIDS NS @ 75 ML/HR
 INJ.MONOCEF 1 GM I.V/BD
 INJ.AMIODARONE 150 MG IV/STAT TAB.ECOSPIRIN-AV 75/10 PO/HS 
INJ.EPO 4000 IU/SC WEEKLY ONCE
 INJ.LASIX 80 MG I.V /STAT
 INJ.LASIX 40 MG IV/BD 
INJ.PAN 40 MG IV/OD
TAB.MET-XL 25 MG RT/OD 
TAB.DILTIAZEM 30 MG RT/BD
 TAB.SHELCAL-CT RT/OD
 INJ.HEPARIN 3000 IU IV/TID
INJ.MGSO4 1 AMP IV/STAT OVER 10 MIN
TAB.OROFER XT RT OD

 Advice at Discharge 
1.TAB.MET-XL 25 MG RT/OD
 2.TAB.DILTIAZEM 30 MG RT/BD 3.TAB.SHELCAL-CT RT/OD
 4.T.PAN 40MG PO/OD
 5.T.TAXIM 2OOMG PO/BD
TAB OROFER XT RT OD 

FOLLOW UP AT 3MONTHS -PATIENT HAS EXPIRED POSSIBILITY DUE TO ARRYTHYMAIS ?

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