A56 YR OLD MALE WITH CKD SECONDARY TO HYPERTENSIVE NEPHROPATHY
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A 56 yr old male patient came with complaints of
- Bilateral pedal edema since 20 days
C/o shortness of breath since 15 days
C/o decreased urine output - since 15days
Pt was apparently asymptotic 3 months back then he developed B/L pedal edema (pitting type) , associated with shortness of breath grade 2-3 , then taken him to hospital pt diagnosed as CKD
He is on conservative management
Now, he came with same complaints since 20 days now adviced for dialysis
Past history : k/C/O HTN since 2 yrs on irregular medication
Not a known case of DM, asthma , TB , Epilepsy
Personal history : farmer by occupation
Appetite : lost since 3 months
Diet : mixed
Bowel movements-regular
Bladder movement s irregular
No H/o addictions
Family history : not significant
On examination :
On general examination :
Vitals :
Pt is C/C/C
Temp -afebrile
BP -160/90 mmHg
PR -99 BPM
RR 18 CPMS -
Spo2 -95% at room air
GRBS- 115 mg%
Pallor +, no icterus , clubbing , cyanosis
Edema + ( B/L pedal edema)
On systemic examination :
CVS : S1S2 +
RS : BAE +
Per abdomen : soft non tender
CNS : NAD
Hb - 8.1 GM/ dl
TC - 8,600
PlTC- 2.79 lakhs
RFT :
Urea :145 mg/ dl
Creatinine :14.4
Uric acid -6.7 mg/ dl
Calcium -7.1
Phosphorus -5.6
Sodium -149 meq/l
Potassium :5.6
Cl - 101 meq/l
CUE :
Albumin : +++
Sugars : nill
LFT :
TB :0.55 mg/ dl
DB : 0.2 mg/ dl
AST :17 IU/ l
ALT : 19 IU/ l
ALP :484 IU/l
TP :5.9 GM/ dl
Albumin :2.2 GM/ dl
A/G - 0.61
Serum protein creatine ratio :4.34
21/12/21
Blood urea -167 mg/ dl
Sr creatinine :13
Uric acid :7.9
Electrolytes
Calcium -7.0 mg/ dl
Phosphorus - 6.3 mg/ dl
Na - 149 meq / l
K - 4.6 meq / l
Cl - 102 meq / l
22/12/21
Blood urea -176 mg/ dl
Uric acid -7.9 mg/ dl
Sr creatinine : 17.3 mg/ dl
Electrolyte s
Na -145 meq / l
K - 4.5 meq/l
Cl -101 meq/l
23/12/21
Hb - 8.2 GM/dl
Urea -126 mg/dl
Creatinine -12.9 mg/dl
Uric acid - 5.8 mg/dl
Ultrasound findings :
Provisional diagnosis : CRF with metabolic acidosis k/C/O HTN since 10 months
Treatment :
1) salt restriction <2.4 GM/day
2) fluid restriction < 1 lit / day
3) Tab LASIX 40 mg PO/TID
4) Tab .NODOSIS 550 mg PO/ BD
5) Tab OROFER XT PO/ OD
6) Tab SHELCAL 500 mg PO/ OD
7) inj Erythropoietin 4000 IU / SC weekly once
8) inj iron sucrose 1 amp in 100 ml NS
9) strict i/o charting
ECG
1) salt restriction <2.4 GM/day
2) fluid restriction < 1 lit / day
3) Tab lasix 40 mg Po/TID
4) Tab .NODOSIS 550 mg po/ BAD
5) Tab OROFER XT po/ of
6) Tab SHELCAL 500 mg po/ of
7) inj Erythropoietin 4000 IU / SC weekly once
8) inj iron sucrose 1 amp in 100 ml NS
9) strict i/o charting
1) salt restriction <2.4 GM/day
2) fluid restriction < 1 lit / day
3) Tab lasix 40 mg Po/TID
4) Tab .NODOSIS 550 mg po/ Bd
5) Tab OROFER XT po/ od
6) Tab SHELCAL 500 mg po/ od
7) inj Erythropoietin 4000 IU / SC weekly once
8) inj iron sucrose 1 amp in 100 ml NS
9) strict i/o charting
http://mounika107.blogspot.com/2021/12/a56-yr-old-male-with-crf.html
1) salt restriction <2.4 GM/day
2) fluid restriction < 1 lit / day
3) Tab lasix 40 mg Po/TID
4) Tab .NODOSIS 550 mg po/ Bd
5) Tab OROFER XT po/ od
6) Tab SHELCAL 500 mg po/ od
7) inj Erythropoietin 4000 IU / SC weekly once
8) inj iron sucrose 1 amp in 100 ml NS
9) strict i/o charting
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