42 year old male with CKD on MHD since 2 years
42 year old male with c/o deceased urine output since 2 months and c/o bilateral swelling of lower limbs since 2 months
Pt was apparently asymptomatic 2 years back then he developed b/l pedal edema which is insidious in onset and gradual in progression with decreased urine output and went to outside hospital where he is diagnosed with kidney disease ,so he started medication
4 months back patient had b/l pedal edema which is pitting type with decreased urine output for which he came to our hospital and was advised to undergo dialysis ,he underwent dialysis for twice weekly and he is on regular dialysis
Now the pt came for dialysis
K/c/o HTN since 4 years and is on medication
No H/O Diabetes, asthma, epilepsy, tuberculosis
He is married ,farmer by occupation with mixed diet,decreased appetite, regular bowel and bladder movements and no known allergies and no addictions
On general examination
Pt is conscious, coherent, cooperative
Pallor present
No icterus, cyanosis, clubbing, lymphadenopathy
Bilateral pitting type of edema of feet present
His vitals are
Bp- 150/100 mm of hg PR-92 bpm
RR-16 cpm
Spo2-98%on RA
GRBS
On systemic examination
CVS- S1,S2 heard,no murmurs
RS- BAE present, NVBS+
P/A- soft,non tender
CNS- NAD
Diagnosis- CRF secondary to hypertension with anemia secondary to chronic renal failure on maintaince haemodialysis since 5 months
Investigations-
CBP:-
Hb-7.2 gm/dl
TLC- 4400 cells/cu mm
Neutophills- 57
Lymphocytes- 33
Eosinophils- 05
Monocytes- 05
Basophills- 00
Platelet count- 2.77lakhs/cu mm
CUE:-
Albumin- ++
Pus cells- 4-5
Epithelial cells- 3-4
Serum iron- 77 microgram/dl
RFT:-
Serum urea-131mg/dl
Serum creatinine-11mg/dl
Uric acid-8.3 mg/dl
Serology- negative
ECG-
Treatment -
1)Fluid restriction upto 1L/day
2) Salt restriction <2 gm/day
3) Inj.LASIX 40 mg IV/BD
4) TAB.NICARDIA 20mg PO/TID
5) TAB.OROFER-XT PO/BD
6) INJ.ERYTHROPOIETIN 4000IU S/C over weekly
7) TAB.SHELCAL 500 mg PO/OD
8) O2 inhalation if Spo2 <92%
9) Strict BP/PR/SPO2 charting 4th hourly, GRBS 6th hrly
