A 48yr old male came for dialysis

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A 48 yr old male with decreased urinary output since 15 days, pedal edema and facial puffiness since 10 days.

HISTORY OF PRESENT ILLNESS-

Patient was apparently asymptomatic 2yrs back then he developed bilateral pedal edema and decreased urinary output. And diagnosed as renal failure.

Shortness of breath G3 insidious in onset and gradually progressive ,pedal edema G2 pitting type

No history of burning micturation

No history of fever

PAST ILLNESS-

History of hypertension 

History of diabetes mellitus type 2

No history of asthma, epilepsy, CAD and CVD

PERSONAL HISTORY-

48yr old male married, farmer by occupation has normal appetite, mixed diet, regular bowels, decreased urinary output, no allergies, chronic alcoholic, no history of smoking

GENERAL EXAMINATION-

Patient was drowsy, incoherent and uncooperative 

Pallor-

No icterus, cyanosis,clubbing, lymphadenopathy

Vitals- 

On presentation-

Temperature-98

BP- 150/90

Pulse rate-95bpm

Respiratory rate-18cpm

GRBS-182mg/dl





SYSTEMIC EXAMINATION-

CVS- S1 and S2 heard, no murmurs heard

Respiratory system- vesicular breath sounds, BAE+

CNS- unconscious speech-normal, no signs of meningitis 

Per abdomen- no tenderness, no organomegaly 

INVESTIGATIONS-

Hemogram 




ECG




Ultrasound




Blood grouping and Rh




LFT





RFT  




SAAG




Serum Iron

























PROVISIONAL DIAGNOSIS-
Chronic kidney disease on maintenance haemodialysis 

TREATMENT-
Rx
T.LASIX 40 mg PO/BD
T.Shelcal 500mg PO/BD
T. OROFER XT PO/OD
T. NICARDIA 10 mg PO/OD
T.NORDOSIS 500mg PO/TID
Inj. HAI 50 SC/TID
Inj EPO 4000 IV/SC once week
Inj iron sucrose 100 mg IV once weekly 
Salt restrictions <2mg/day $fluid restriction <1.5L/d
Inj.Augmentin 1.2gm Iv/BD



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