A 62 year old male patient with CKD

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A 60 year old male, who is a resident of Nalgonda ,farmer by occupation came with 

 Chief complaints

-Pedal edema since 3 months

-shortness of breath since 20 days

- decreased  urine output since 15 days

History of presenting illness

The patient was apparently asymptomatic 3 months back then developed bilateral pedal edema initially extending to ankle Gradually progressed up to thighs which worsened during last 15 days.

Decreased urine output since 15 days, not associated with frequency, urgency burning micturation.

Grade 3 shortness of breath, noaggravating and relieving factors.

PAST HISTORY

Known case of hypertension since 6 months.

No history of diabetes mellitus, asthma, cardiovascular disease , epilepsy, tuberculosis.

no history of blood transfusions.

FAMILY HISTORY

Hypertension is present (father)

No history of Diabetes mellitus, epilepsy, tuberculosis, cardiovascular disease,asthma.

PERSONAL HISTORY 

Married.

Farmer by occupation.

Mixed diet.

Sleep adequate.

Bowel-Regular.

Bladder-Irregular.

No allergies known.

Occasionally consumes alcohol. 

Smokes tobacco.

GENERAL EXAMINATION

Patient is conscious coherent cooperative.

Pallor, clubbing ,pedal edema are present.

 Icterus,Cyanosis, lymphadenopathy are absent.

VITALS

Temp:99.1°F

PR: 98

Rr: 29/ min

Bp:100/80 mm Hg. 

Spo2: 84%

GRBS:124 mg/dl

Cardiovascular system: 

-S1,S2 heard .no mumurs.

Respiratory system:

-Position of trachea central.

- Bilateral airway entry present.

-Dyspnea present .

- no wheeze.

Abdomen:

-Scapoid

-No tenderness.

-No palpable mass.

-Spleen : not palpable.

-liver : not palpable.

CNS examination:

-Conscious .

-no signs of meningeal irritation.

INVESTIGATIONS

28/11/23

HEMOGRAM 

- Hemoglobin:5.4gm/dl.

-total count: 26,800

-Neutrophils- 89

-lymphocyte:5

-eosinophil:06

- monocyte :0

-Basophils:0

-PCV : 16.1

-MCV : 84.1

-MCH : 28.1

-MCHC : 33.4

-RDW -CV :22.9

-RDW-SD : 66.3

- platelet count : 1.32

Impression: Normocytic Normochromic with neutrophilic leukocytosis and thrombocytopenia.

RENAL FUNCTION TEST

Urea :  131mg/dl

Creatinine 4.6 mg /dl 

Uric acid 9.9 mg/dl

Calcium 10.1 mg/dl 

Phosphorus 5.1 mg /dl 

Sodium 137 meq /l 

Potassium 4.1 meq / l 

Chloride 102 meq/l

Abg 

PH 7.46

Pco2 29.4 mmhg 

Po2 1 mmHG 

Hco3 20.7 mol /l 

Tco2 44.9vol 

O2 sat 98.8 % 

O2 count 8.9vol %

HIV 1/2 Rapid : Non reactive

Anti HCV antibodies Rapid : Non reactive

HBsAg Rapid : negative

ECG

29/11/23

HEMOGRAM

- Hemoglobin:5.4gm/dl.

-total count: 22,300

-Neutrophils- 91

-lymphocyte:4

-eosinophil:0

- monocyte :5

-Basophils:0

-PCV : 16.2

-MCV : 84.4

-MCHC : 28.3

-RDW -CV :22.1

-RDW-SD : 66.9

- platelet count : 1.52

Impression: Normocytic Normochromic with neutrophilic leukocytosis.

RENAL FUNCTION TEST

Urea 146 mg/dl 

Creatinine 7.7 mg /dl 

Uric acid 10.8 mg/dl

Calcium 9.9 mg/dl 

Phosphorus 5.6 mg /dl 

Sodium 129 meq /l 

Potassium 4.7 meq / l 

Chloride 89 meq/l

Abg 

PH 7.74 

Pco2 25.9 mmhg 

Po2 46.1 mmHG 

Hco3 19 mol /l 

Tco2 43.3 vol 

O2 sat 92.4 % 

O2 count 2.4 vol %

2D ECHO

USG

PROVISIONAL DIAGNOSIS

Chronic kidney disease with anemia 

TREATMENT 

On 28 /11/23 

Patient was on salt restriction < 1.5 g / day 

Patient was on fluid restriction <1.5l per day 

Inj : PIPTAZ 2.25 gm iv /tid 

Inj LASIX 40 mg iv /bid 

Inj MEOMOL 14 mg iv sos if temp >101 

Tab : ECOSPRIN 50mg H/S 

Tab : OROFER once a day 

Tab DOLO 650 mg every 6 hourly 

Tab NODOSIS 500 mg PO /BD 

Tab SHELCALT 500 mg /BD

TREATMENT 

On 29/11/23

TAB. LINOD 10mg twice a day. 

Inj LASIX : 40 mg Iv twice a day 

Tab : Oral NODOSIS 500 mg twice a day 

Tab: Oral SHELCAL 500 mg twice a day

Inj.EPO 4000 IU ,SC once weekly

Tab : oral ECOSPRIN 75mg H/S

Inj NEOMAL : 14mg IV sos 

Tab : DOLO 650 mg QID

Inj PIPTAZ : 2.25 gm I.v thirice a day. 

TREATMENT

On 30 /11/23 

Treatment 

Inj PIPTAZ : 2.25 gm I.v twice a day. 

Inj LASIX : 40 mg Iv twice a day 

Inj NEOMAL : 14mg IV sos 

 Tab : Oral NODOSIS 500 mg twice a day 

Tab: Oral SHELCAL 50 mg twice a day 

Tab : oral ECOSPRIN 50mg H/S

Tab OROFER once a day 

Tab : DOLO 650 mg QID

Intermittent CPAP 

Oxygen supplementation 1-2 l