A 48 year old male with CKD on MHD
A 48 year old male resident of haliya autodriver by occupation . He was a lorry driver for 10 years .
He was apparently asymptomatic 5 years back .Then he developed fever for which he went to hospital and was diagnosed with DM and is on medications . For 3 years he used oha for Dm and from 2 years he is using insulin.
2 years back he had fever and went to hospital and was diagnosed with hypertension and is on regular medications .
6 months back he had swelling of neck and went to hospital and was diagnose with hypothyroidism and is on medications .
3 months back he had generalised edema for 2 days and sob for 2 days .He went to local hospital in nalgonda and he was referred to kamineni in view of raised creatinine levels .
After admission , investigations were done and was found to have raised urea and creatinine and pt was started dialysis.
5 dialysis were done and sob and pedal edema were relieved and was discharged.
Total 20 dialysis were done thrice weekly.
Today he again came for dialysis and was having sob when walked for some distance.
Past history:
K/c/o DM since 5 years and HTN since 2 years .
Not K/c/o asthma , tb , epilepsy ,cad
Personal history:
Diet: mixed
Appetite : normal
Sleep: adequate
Bowel and bladder: regular
Addictions:
O/E:
Pt c/c/c
Bp: 150/80 mm of hg
PR: 84/min
CVS: s1 s2 present
Rs: BAE present , NVBS
P/A: Soft, non tender
CNS: intact
Investigations:
On 2/9/21:
Hemogram:
Hb-7.4
TLC-8600
Plt-2.29
RFT:
Urea- 119
Creatinine- 8.0
UA- 8.7
Na+ : 133
K+ : 3.4
Cl- : 98
X-ray:
Investigations: on 5/11/21
CBP-
Hb : 6.3
TLC- 15300
PLT- 4.26
CUE:
Albumin ++
Sugars - ++++
Pus cells - 4 to 6
Epithelial cells - 2 to 4
RFT:
Blood urea - 59
Serum creatinine - 5.9
Na+ : 133
K+ : 3.7
Cl- : 86
Serum iron: 40 ug/dl
ECG:on 8/11/21:
Treatment:
1. Fluid restriction <1.5 lit/day
2.salt restriction <2 gm/day
3. Tab lasix 40 mg po BD
4. Tab nicardia 20 mg po tid
5. Tab met xl 50 mg po bd
6. Tab thyronorm 50 mcg po od
7. Tab . Drogen po bd
8.Inj. Actrapid 6u 6u 4u
9.Nebulisation with budecort 12th hrly , duolin 8th hrly
10.Tab cinod 10 mg po bd
11. Inj erythropoietin 4000 IU sc weekly once .
12. Inj. Iron and sucrose 100 mg in 100 ml ns IV OD weekly
