case 9

Case 9- 60year old female
DOA -5/5/2024
DOD-11/5/2024
CKD DURATION -not known 

Diagnosis
CHRONIC RENAL FAILURE
?HEPARIN INDUCED THROMBOCYTOPENIA 

CHIEF COMPLAINTS -

 C/O SOB SONCE 1 WEEK C/O FEVER SINCE 4 DAYS C/O ANURIA SINCE 3 DAYS B/L PEDAL EDEMA SINCE 1 DAY

HOPI
PT WAS APPARENTLY ASSYMPTOMATIC 1 WEEK BACK AFTER WHICH SHE STARTED HAVING BREATHLESSNESS GRADUALLY PROGRESSIVE AND A/W FVER AND CHILLS ANURIA SINCE 3 DAYS.
B/L PEDAL EDEMA PITTING TYPE EXTENDING TILL KNEE
H/O HEMODIALYSIS IN THE PAST 4 YRS AND AV FISTULA PERFORMED FOR BOTH HANDS WHICH FAILED EVENTUALLY
H/O RIGHT HYDRONEPHOSIS AND LEFT VUJ CALCULUS IN THE PAST AND WAS TREATED.H/O 2 ADMISSIONS IN THE PAST 4 YRS FOR OBSTRUCTIVE UROPATHY AT OUR CENTER AND GOT DIALYSED NOT ON HD SINCE 2 YRS.
O/EPALLOR + PEDAL EDEMA + 

TEMP - 100F
PR - 102 BPM
RR- 26 CPM
BP- 100/60 MM HG
SPO2- 96% AT RA
GRBS-105
CVS-S1 S2 +
RS- BAE+ NVBS HEARD
CNS - NFND
P/A-SOFT NONTENDER


4 SESSIONS OF HEMODIALYSIS WERE DONE ,LAST SESSION WAS ON 10/5/24
2 PRBC TRANSFUSION DONE DURINGDIALYSIS
URINE C&S REPORT- KLEBSIELLA PNEUMONIA ISOLATED ,SENSITIVE TO
NORFLOXACIN,OFLOXACIN,CEFTRIAXONE,PIPTAZ,MEROPENEM,FOSFOMYCIN,COTRIMOXA
ZOLE
Investigation

LFT
 Total Bilurubin1.36 mg/dl
Direct Bilurubin0.48 mg/dl
SGOT(AST)12 IU/L
SGPT(ALT)14 IU/L
ALKALINE PHOSPHATASE247IU/L
TOTAL PROTEINS5.7 gm/dl
ALBUMIN3.1 gm/dl
A/G RATIO1.19

RFT 
UREA 218 mg/dl
CREATININE9.1 mg/dl
URIC ACID11.3 mmol/L
CALCIUM8.7 mg/dl
PHOSPHOROUS 3.0 mg/dl
SODIUM 136 mmol/L
POTASSIUM 4.4 mmol/L.
CHLORIDE105 mmol/L
COMPLETE URINE EXAMINATION (CUE)
COLOUR
ALBUMIN ++
SUGAR Nil


On 10/05
HEMOGRAM
HB 8.7
TLC 4600
PCV 23.1
MCV 90.9
MCH 34.3
MCHC 37.7
PLT -30000

PERIPHERAL SMEAR -NORMOCYTIC NORMOCHROMIC 

S.IRON -53
S.FERRITIN -329.6

2d ECHO -EF-52%
 Grade 1 diastolic dysfunction 

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

Treatment Given
FLUID <1.5LT/DAY
SALT RESTRICTION <2G PER DAY
INJ EPO 4000 IU/SC ONCE WEEKLY DURING DIALYSIS
TAB NORFLOXACIN 400MG PO OD
TAB LASIX 40MG/IV/TID
T UROFER XT PO/OD
T NODOSIS 500MG PO/OD
TAB PAN 40 MG PO OD
TAB SHELCAL CT RT/OD TAB PCM 650MG PO TID VITALS MONITORING 2 HRLY

Advice at Discharge
 FLUID <1LT/DAY
SALT RESTRICTION <2G PER DAY
TAB.NODOSIS 500MG PO/OD
INJ ERYTHROPOIETIN 4000 IU SC ONCE WEEKLY 
INJ.IRON SUCROSE 1AMP IN 100 ML NS IV OD ON ALTERNATE DAY 
TAB.OROFER XT PO OD
TAB LASIX 40 MG PO BD 8AM AND 3 PM

FOLLOW UP AFTER 3MONTHS 
HB -9.6
MCV -82.3
MCH-34.3
MCHC-37.7
TLC -4600
PLT-1.50

AT THE END OF APRIL -
PATIENT EXPIRED AT GOVERNMENT HOPSITAL - ? ACUTE PULMONARY ODEMA 

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