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A 52 yr old male resident of Mothkur, farmer by occupation came to the OPD with chief complaints of shortness of breath , and swelling on both legs and there was decreased urine output .
History of Present illness :
Patient was apparently asymptomatic 1 month back . Then he complained of bilateral pedal edema which was gradually progressive pitting type . He also complained of decreased urine output . This caused him great disstress and considerably decreased his apetite . He went to nearest hospital on 11 -07 -2021 where he finally diagnosed with CKD on MHD , Diabetic nephropathy and Hydrocoel . He underwent 5 sessions of dialysis on 15-07-2021 , 17-07- 2021 , 19 -07-2021 , 21-07-2021 ; 23-07-2021 .
5 days back patient came to casuality with swelling in legs ,chest pain and undergone 4 dialysis.
PAST HISTORY :
●Patient was known case of diabetes mellitus type 2 from past 10 years.
● Patient was also known case of Hypertension from past 4 years
● Pateint was undergone surgery 5 years back due to swelling of scrotum, occurs as a result of fluid collected in thin sheath surrounding a testicle.
● Patient was known case of CKD on MHD
● Not a known case of epilepsy ,TTS
PERSONAL HISTORY :
• Micturition abnormal
• Decrease apetite
• No adequate sleep
• Mixed diet
• No smoking addiction
• Regular alcohol addiction
• Bowel and bladder movements are irregular.
FAMILY HISTORY:
● There is no case of such illness seen in her family members
● There is no history of Hypertension and diabetes in the family .
TREATMENT HISTORY:
• Patient is undergoing drug therapy for diabetes and hypertension
• He is taking insulin for daibetes since 9 years
• Presently he is taking Nefidinol of 25mg for hypertension
• No known allergy for drugs
GENERAL EXAMINATION:
• Patient is consious coherent and cooperative
• There is pedal edema
• No cynosis No clubbing and No lymphadenopathy.
Vitals :
• Pulse rate - 98bpm
•Blood pressure - 160/100
• Respiratory rate - 8cpm
• SpO2 at room air - 98%
• Temperature - Afebrile
SYSTEMIC EXAMINATION:
1. Cardiovascular system:
• Thrills - No
• Cardiac sounds - S1 and S2 heard
2. Respiratory system:
• Dyspnea - present
• No wheezing
• Position of trachea - central
• Bilateral air entry +
• Normal vesicular breath sounds - heard
3. Abdomen :
• Shape of abdomen - obese
• No tenderness
• No palpable mass
• Liver and spleen are not palpable
4. Central nervous system:
• Patient is conscious
• Speech - Normal
• Sensory and motor reflexes - intact
• No signs of meningeal irritation
FINAL DIAGNOSIS :
• Chronic kidney disease on maintenance hemodialysis .
•Hypertension and Type 2 diabetes mellitus
INVESTIGATION:
RFT :
Urea : # 94mg/dl
Creatinine : #3.0mg /dl
Uric acid : 6.9mg / dl
Calcium : 9.6mg/dl
Phosphorus: 4.3mg /dl
Sodium : #135 mEq / L
Pottasium : 3.5 mEq / L
Chloride: 101 mEq/ L
Fasting blood sugar : #193mg/dl
Post lunch blood sugar : #219mg/dl
Serum Iron : 71ug/dl
Glycated haemoglobin: HbA1c- 7.1%
Hemogram :
Haemoglobin : #9.8 gm/dl
Total count : 8700 cells / cumm
Neutrophils : 73%
Lymphocytes : #18%
Eosinophils : 04%
Monocytes : 05%
Basophils : 00%
PCV : #26.7vol%
MCV : # 74.6 fl
MCH : 27.4 pg
MCHC : # 36.7 %
RBC count : 3. 58 millions / cumm
Platelet count : 3.02 lakhs / cumm
Smear :
RBC - Microcytic hypochromic
WBC - Within normal limit
Platelets - Adequate
Hemoparasites - No hemoparasties seen
Impression - Microcytic hypochromic Anemia
ECG
Ultra sound report form :
Treatment :
INJ. LASIX 40mg IV / BD
TAB. NICARDIA 10mg PO / TID
TAB. OROFER - XT PO /BD
INJ. ERYTHROPOIETIN 4000IU S/C once weekly
Tab. SHELCAL 500mg PO / OD
Tab. NODOSIS 550mg PO / BD
Fluid restriction upto 1Lit / day
Salt restriction <2gm / day
DISCUSSION :
1 . What is the sudden causeof renal failure ? If it is due to daibetes then when did it actually started failing as patient was diabetic since 10 years ?
2. Why do most CKD cases have hypertension?
3. Cant we early diagnosis CKD ?
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