55 year old male with CKD on MHD

55 YR OLD MALE WITH CKD ON MHD. Patient came with complaints of Pedal edema & SOB since 3 months


This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book reflects my patient-centered online learning portfolio and your inputs on the comment box is welcomed

Patient came with complaints of 
           -     Reduced urine output 
           -     Pedal edema
           -     SOB   since   3 months

Patient  was apparently asymptomatic  8 months back  , then he  developed  knee & ankle pain  in both lower limbs , then he went to local hospital and took medication for that pain relief.
He used that medication for 4-5 months, after which he developed pedal edema which was pitting type &
SOB , which was grade 2-3 (NYHA) since 3 months.

Past history : Patient is a known case of hypertension since 3 months.  Not a known case of Diabetes mellitus,  asthma,TB, epilepsy
Personal history :
 Diet - mixed
Appetite - normal
Bowel & Bladder movements - regular
Sleep - adequate
Addictions -

Family history : not significant

ON EXAMINATION :
Pt is C/C/C
Temp : afebrile
BP : 140/80 mmHg
PR : 82 BPM
RR : 22 CPM
GRBS : 105 mg%
General examination
Pallor + , no icterus , Cyanosis , Clubbing, lymphadenopathy
B/L Pedal edema till knee +

SYSTEMIC EXAMINATION:
CVS : S1,S2 heard, no added murmurs
RS : Bilateral air entry present, Trachea is central, vesicular sounds heard
Per abdomen : soft, non tender, bowel sounds heard
CNS : No abnormal deficits seen




INVESTIGATIONS

ECG
           

2D ECHO:


Chest x-ray




          



PROVISIONAL DIAGNOSIS:
 CKD on MHD Secondary to NSAIDS Induced nephropathy

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

On 4th March 2022, he had 1 session of hemodialysis in the morning and he was discharged in the evening



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