case 6


CASE 6 80YEAR OLD MALE
DOA-11/5/2024
DOD-20/5/2024
CKD DURATION- 5YEARS
DIAGNOSIS -CHRONIC RENAL FAILURE


 CHIEF COMPLAINTS:
PATIENT CAME WITH CHIEF COMPLAINTS OF SOB SINCE 1 DAY LOSS OF APPETITE SINCE 7 DAYS COUGH SINCE 7 DAYS HOPI:
PATIENT WAS APPARENTLY ASYMPTOMATIC 7 DAYS AGO AND HE DEVELOPED COUGH SINCE 7 DAYS ,CONTINUOUS TYPE,NOT ASSOCIATED WITH SPUTUM,DRY COUGH,SORE THROAT, NO AGGRAVATING AND RELIEVING FACTORS ASSOCIATED WITH LOSS OF APPETITE SINCE 7 DAYS,WEIGHT LOSS AND SOB SINCE 1 DAY(GRADE2 MMR). N/H/O FEVER,COLD,ALLERGIES,BURNING MICTURITION,CONSTIPATION,PAIN ABDOMEN

 PAST HISTORY:
N/K/C/O HTN,DM,CVA,CAD,EPILEPSY,THYROID DISORDER,ASTHMA,TB GENERAL EXAMINATION:
PATIENT CONCIOUS COHERENT COOPERATIVE TEMP 96.5F PULSE 111 BPM RR 27/MIN
BP 100/70 mmHg
SPO2 98%
GRBS:96 MG/DL
NO ICTERUS PALLOR CYANOSIS LYMPHADENOPATHY CLUBBING


SYSTEMIC EXAMINATION:
CVS:S1S2 HEARD , NO MURMURS.
RS :BAE NORMAL, NVBS
CNS :NO FOCAL NEUROLOGIC DEFICIT
P/A:SOFT,NON TENDER,NO ORGANOMEGALY


Investigation
pH -7.1
PCO2 17.3
PO2 97.8
HCO3 5.9
St.HCO3 8.8
Po2-98
ALBUMIN +
SUGAR NiL
RFT
UREA 201 mg/dl
CREATININE 5.0 mg/dl
URIC ACID 8.7 mmol/L
CALCIUM 10.0mg/dl
PHOSPHOROUS 6.0 mg/dl
SODIUM 139 mmol/L
POTASSIUM 4.7 mmol/L.
CHLORIDE 106mmol/L
 
HEMOGRAM:
HB:7.1
MCV-83.4
MCH-35
MCHC-33.1
TLC:9200
RBC:2.39

S.iron-40
S.ferritin-287.1

PLT:2.0

2d echo
EF -58%
Grade 1 diastolic dysfunction 
LVH present 

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 -0
 

Treatment Given(Enter only Generic Name)
 1.IV FLUIDS NS@75ML/HR 2.INJ.CEFTRIAXONE 1GM IV/BD 
3.INJ PAN 40 MG IV/OD/8AM
 4.TAB .TAMD 0.4 PO/HS
5.TAB NODOSIS 1000MG PO/OD TID
 6.INJ LASIX 40MG IV/IF SBP 110 MMHG 7.STRICT I/O CHARTING 

Advice at Discharge 
1.INJ PAN 40 MG IV/OD/8AM
 2.TAB .TAMD 0.4 PO/HS
3.TAB NODOSIS 1000MG PO/OD TID
 4.INJ LASIX 40MG PO/BD 


FOLLOW UP AFTER 3MONTHS 
HB-9.7
TLC -6700
MCV-87.3
MCH-29.8
MCHC-30.1
PLT-2.14


FOLLOW UP AT THE END OF THESIS 
HB -10.1
MCV-87.2
MCHC-28.3
MCH-29.1
TLC-7800
PLT -2.51

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