50 year old male on MHD

 A 50 year old male patient is on maintainance haemodialysis since 10 months.

HOPI: patient was apparently asymtomatic 4yrs back and then developed shortness of breath (on and off), pedal oedema (pitting type).Later diagnosed as chronic renal failure and underwent dialysis twice weekly for about 10 months.

6 years back he met with an accident. His right leg got fractured and it took nearly 1 year to heal for which he used few medication continuosly for 1 year.

PAST HISTORY: k/c/o HTN since 1 year.

Not a K/C/O of DM, thyroid disorders, TB

PERSONAL HISTORY:He follows a mixed diet. Appetite -Normal, Bladder movements-normal,

Bowel movements-constipation since few weeks. Sleep- decreased.consumes alcohol regularly(90ml ) and stoped consuming1 year back.

He is a farmer and stopped working since 1 year.

FAMILY HISTORY: No significant family history.

DRUG HISTORY: No known drug allegies and patient uses Nicardia 10 mg.

General examination : patient is conscious ,coherrent, co operative and well oriented to his surroundings.he is poorly built and nourished.no pallor ,no cyanosis, no icterus, no lymphadenopathy. bilateral pedal edema is seen and is of pitting type 

Vitals:. Temperature: afebrile. Pulse rate: 98 beats / min. Respiratory rate: 19cycles / min. Bp: 190/100. Spo2: 99 

Systemic examination: 

Cvs: bilaterally symmetric chest wall .no precordial bulge .no thrills and no murmurs.

S1& S2 heard.

Respiratory system: no dyspnoea, no wheeze

Position of trachea- central, no adventious sounds heard

CNS: patient is normal and concious .reflexs are normal.

CLINICAL IMAGES:

Investigations: 31/1/22

RFT: urea-157.  Cr.10.2.   UA-9.8

USG- Rt Grade 3 RPD

          Lt  grade 2 RPD

2D ECHO- trivial TR+ /AR+, no MR.

Good LV systolic function.

Diastolic dysfunction (+)

ECG:

2/2/22:

LFT: 

T.b-0.9.  D.B- 0.2.  SGOT-17.    SGPT-15.    ALKP- 504.   TP-5.6.   ALB-3.6.   A/G RATIO-1.80

RFT: U-178.  CR-10.2.  U A-9.0. CALCIUM-9.4. P-4.5.  Na-140.   K-4.7.   Cl-102

S.iron 78

RBS- 70

CUE: ALB++.   SUGARS-TRACE.  RBC's, CRYSTALS, CASTS-NIL

HAEMOGRAM

HB-5.8.   TLC-7400.   LYMPHOCYTES -13

PCV-17.4.   RBC COUNT-2.01.  PLT-1.20.    

NORMOCYTIC NORMOCHROMIC ANEMIA WITH THROMBOCYTOPENIA.

PROVISIONAL DIAGNOSIS:

NSAID ASSOCIATED RENAL IMPAIRMENT.

TREATMENT: 

(1) TAB.LASIX 40MG PO/BD

(2) TAB.NICARDIA 10 MG PO/BD

(3)TAB.NODOSIS 500MG PO/BD

(4)TAB.OROFER -XT PO/OD

(5)TAB.SHELCAL-CT PO/OD

(6)INJ.ERYTHROPIEOTIN 4000IU S/C ONCE WEEKLY

(7) SALT AND FLUID RESTRICTION.