86year old



DATE OF DISCHARGE -4/3/24


DIAGNOSIS 

CHRONIC RENAL FAILURE SECONDARY TO DIABETIC NEPHROPATHY LEFT DISTAL TIBIA PLATING WITHOUT DNVD K/C/O DIABETES MELLITUS K/C/O HYPERTENSION K/C/O CKD
CHEIF COMPLAINTS -
PATIENT CAME WITH C/O REDNESS AND ITCHING OVER LEFT FOOT AND LEG SINCE 3 DAYS SLAB WAS REMOVED- SKIN EXCORIATION PRESENT
SLAB CARE NOT TAKEN PROPERLY AND SLAB HYGEINE WAS NOT MAINTAINED PATIENT IS K/C/O DMT2 ON MEDICATION INJ.HAI 6U-6U-6U K/C/O HTN ON T.CLINIDIPINE 10MG PO OD
N/K/C/O ASTHMA,COPD,TB,EPILEPSY AND THYRIOD DIORDERS


 GENERAL EXAMINATION
 PATIENT IS C/C/C
NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY AND PEDAL EDEMA TEMP - AFEBRILE PR- 96 BPM
BP - 120/80 MM HG 
PR- 96 BPM
 CVS- S1S2 HEARD ,NO MURMURS
RS - BILATERAL AIR ENTRY PRESENT
P/A - SOFT,NON TENDER,NO ORGANOMEGALY
CNS - NFND

CASE WAS THEN TRANSFERRED TO NEPHROLOGY I/V/O DERANGED RFT
AFTER TRANSFERRING TO NEPHROLOGY PATIENT WAS INITIATED ON HEMODIALYSIS IN
VIEW OF DERANGED RENAL PARAMETERS
DURING FIRST SESSION OF HEMODIALYSIS PATIENT DEVELOPED HYPOTENSION DURING
DIALYSIS AND DIALYSIS WAS STOPPED AND NORADRENALINE INFUSION WAS STARTED
AND CONTINUED TO MAINTAIN MAP>65MM HG.SECOND SESSION OF DIALYSIS WAS UNEVENTFUL AND NORADRENALINE INFUSION WAS
CONTINUED.AGAIN DURING THIRD SESSION OF DIALYSIS PATIENT DEVELOPED HYPOTENSION AND
NORADRENALINE INFUSION WAS INCREASED AND CONTINUED HEMODIALYSIS BUT HER
HYPOTENSION DIDNOT GET RELIEVED AND DIALYSIS WAS STOPPED.
PATIENT WAS ADVISED FOR FOLLOW UP FOR FURTHER SESSIONS OF HEMODIALYSIS AND
DISCHARGED.


Investigation
HEMOGRAM 28/2/24
HB-11.6
MCV -80.3
MCH-27.4
MCHC-29.4
TLC-6300
PLT-1.50

S.IRON-69
S.FERRITIN -187

RFT
BLOOD UREA 338 mg/dl
SERUM CREATININE 11.3 mg/dl
SODIUM 141 mEq/L
 POTASSIUM 4.8 mEq/L 
CHLORIDE 100 mEq/L

LIVER FUNCTION TEST 
 Total Bilurubin 3.15 mg/dl
 Direct Bilurubin 0.46 mg/dl 
SGOT(AST) 10 IU/L 
SGPT(ALT) 10 IU/L
ALKALINE PHOSPHATASE 
129 IU/L 
TOTAL PROTEINS 7.2 gm/dl
 ALBUMIN 2.9 gm/dl 
A/G RATIO 0.69

USG ABDOMEN AND PELVIS

B/L KIDNEYS SHOW DECREASED SIZE AND GRADE II -III RPD CHANGES

 2D ECHO SHOWED TRIVIAL MR +,NO MR/AR
NO RWMA.NO MS/AS.SCLEROTIC AV EF 60%
GOOD LV SYTOLIC FUNCTION GRADE II DIASTOLIC DYSFUNCTION +.NO PAH/PE

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -ONCE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -0
ADMISSION IN ICU -0


Treatment Given(Enter only Generic Name) FLUID RESTRICTION LESS THAN 1.5 L/DAY SALT RESTRICTION LESS THAN 2-3 G/DAY
INJ.NORADRENALINE INFUSION @ 7 ML/HR(INCREASE/DECRTEASE TO MAINTAIN MAP LESS THAN 65 MM HG)
 IN.HAI S/C TID
TAB.NODOSIS 500 MG PO OD 
TAB.SHELCAL 500 MG PO OD
 TAB.OROFER XT PO OD
NEB WITH SALBUTAMOL 8TH HRLY STRICT I/O CHARTING 

Advice at Discharge
FLUID RESTRICTION LESS THAN 1.5 L/DAY SALT RESTRICTION LESS THAN 2-3 G/DAY IN.HAI S/C TID 6U - 6U - 6U 
INJ EPO 4000IU S/C ONCE A WEEK TAB.NODOSIS 500 MG PO OD
 TAB.SHELCAL 500 MG PO OD 
TAB.OROFER XT PO OD
 TAB LASIX 40MG PO BD


FOLLOW UP AFTER 3MONTHS 
HB -10.8
MCV -79.3
MCH-26.5
MCHC-30.1
TLC -7200
PLT-2.15

FOLLOW UP AT THE END OF THESIS -
PATIENT EXPIRED DUE TO SEPTIC SHOCK UROSEPSIS 

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