case 8


64year old female

DOA -10/01/24
DOD -14/1/2
CKD DURATION -not known 

DIAGNOSIS -

CHRONIC RENAL FAILURE STAGE V CKD SECONDARY TI DIABETIC NEPHROPATHY UREMIC GASTRITIS
ANEMIA SECONDARY TO CKD ACUTE PULMONARY EDEMA (RESOLVING) T2DM,HTN+,OLD CVA

HOPI
63 YEARS OD FEMALE CAME TO NEPHROLOGY OPD WITH C/O SOB SINCE 10 DAYS LOW GARDE FEVER SINCE 10 DAYS PEDEAL EDEMA ISNCE 6 MONTHS HOPI:
PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS AGO THEN SHE DEVELOPED SOB OF GARDE III ,COUGH INITIALLY DRY,THEN SINCE 2 DAYS BLOOD STAINED ,VOMITINGS SINCE 6 DAYS,3-4 TIMES A DAY,RELIEVING ON MEDICATION ,NON BILIOUS ,NON PROJECTILE, FOOD PARTICLES AS CONTENT
NO H/O LOOSE STOOLS,ABDOMINAL PAIN,SORE THROAT,PALPITATIONS,CHEST PAIN .
PAST HISTORY
K/C/O HTN SINCE 10 YEARS ON TAB TELMA H PO OD K/C/O DM TYPE 2 SINCE 7 YEARS ON
 TAB METFORMIN 500MH PO OD 
N/K/C/O CAD,EPILEPSY,TB ETC
H/O CVA 5 YEARS AGO(RIGHT HEMIPARESIS) RELIEVED ON MEDICATION AFTER 20 DAYS
STOPPED MEDICATION AFTER 20 DAYS



GENERAL EXAMINATION
PT IS C/C/C
BP-140/80MMHD
PR-84BPM
SPO2-99
RR-18CPM
SYSTEMIC EXAMINATION
CVS-S1S2+
RS-NVBS
B/L BASAL CREPTS ( FINE)
CNS-NFND
P/A
SOFT ,NT

Investigation
2D ECHO ON 11/1/2024
CONCENTRIC LV +,NO RWMA
ECCENTRIC TR+/MR+
MODERATE TR+,PAH+,MODERATE AR+
MILD TO MODERATE MR+
SCLEROTIC AV,NO AS/MS
EF 65%
GOOD LV SYSTOLIC FUNCTION ,NO PE
DIASTOLIC DYSFUNCTION
IVC SIZE 1.62CMS,COLLAPSING,MILD DIALATED
ALL CHAMBERS COLLAPSING

10/1/24
HAEMOGRAM :
HB-7.8
MCV-77.2
MCH-24.7
MCHC-28.1
TLC-22200
PLT - 2.8

S.Iron-86
S.ferritin -169.2

 RFT :
BLOOD UREA:155
S.CREATININE:6.9
SERUM SODIUM:137
 POTASSIUM:4.5 
CLORIDE:106 

 LFT :
TB-1.53
 DB-0.70 
SGPT-770 
SGOT-1133
ALKALINE PHOSPHATE :242
 TOTAL PROTEINS 5.6 
ALBUMIN 2.57
 TROPININ:695.8

CKD DURATION -UNKNOWN

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
 FLUID RESTRICTION <1.5LT/DAY SALT RESTRICTION <2GMS/DAY
 INJ PIPTAZ 2.25GM IV TID AT  INJ PAN 40MG IV OD
INJ IRON SUCROSE 100MG IV DURING DIALYSIS
 INJ DOBUTAMINE 250MG (5ML)+45ML NS '5MCG/KG/MIN
 TAB CLINIDIPINE 5MG PO OD AT 9PM
INJ HUMAN ACTRAPID INSULIN SC TID 8AM-
INJ EPO 4000 IV SC DURING ALTERANTE DIALYSIS
 TAB SHELCAL CT PO OD AT 8PM
 TAB OROFER XT PO OD AT 6AM TAB ECOSPRINE AV 75/10 PO HS 


Advice at Discharge
FLUID RESTRICTION <1.5LT/DAY SALT RESTRICTION <2GMS/DAY 
TAB FEROPENEM 300MG PO OD TAB CLINIDIPINE 5MG PO OD AT 9PM
INJ HUMAN ACTRAPID INSULIN SC TID 8AM-1PM-8PM TAB SHELCAL CT PO OD AT 8PM TAB OROFER XT PO OD AT 6AM TAB ECOSPRINE AV 75/10 PO HS

FOLLOW UP AFTER 3MONTHS 
HB-6.9
MCV -77.0
MCH-23.7
MCHC -28.1
TLC -11000
PLT -2.1


FOLLOW UP AT THE END OF THESIS
PATIENT HAS EXPIRED AT HOME
REASON UNKNOWN (ASSUMED ACUTE PULMONARY ODEMA)/CVA


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