53 yr old female with CKD with k/c/o HTN since 6years
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Case
A 53 year old woman resident of rasilapuram presented to the OPD with chief complaints of breathlessness since 6 months and decreased urine output since 3 months
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 5 years back, then had fever which was insidious and associated with chills, vomiting and pain in the loin for which she went to outside hospital where she was diagnosed with kidney disease, from then she was on medication.
7 months back she stopped medication for 1 month, then after that she developed shortness of breath for which she went to a local hospital where she was referred to our hospital.
She was diagnosed to have chronic kidney disease and adviced to get hemodialysis done
From then on she was on hemodialysis twice weekly.
Now for the past 3 days she is complaining of high grade fever which was associated with chills and rigors and nausea , vomiting of 2 episodes non billions, non projectile, food as content
Not associated with pain abdomen or loose stools
PAST HISTORY :
K/c/o hypertension since 6 years
Not a known case of CAD, Asthma,TB, Epilepsy, Thyroid disorders.
No history of sugeries and blood transfusions in the past.
Patient is a vegetarian diet
Her life style has changed after undergoing dialysis as her appetite was decreased and she is not able to resume her works like working in the farm
There are similar complaints in the family (The patient's mother and sister had suffered from the similar condition).
No cancer deaths in the family.
On examination, patient is conscious, coherent, cooperative
She has Pallor.
No icterus, cyanosis, clubbing, lymphadenopathy, edema
VITALS:
Temperature - 99 F
BP - 100/50 mg
PR - 118 bpm
RR - 16 cpm
GRBS - 135 gm/dl
Investigation :
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 5 years back, then had fever which was insidious and associated with chills, vomiting and pain in the loin for which she went to outside hospital where she was diagnosed with kidney disease, from then she was on medication.
7 months back she stopped medication for 1 month, then after that she developed shortness of breath for which she went to a local hospital where she was referred to our hospital.
She was diagnosed to have chronic kidney disease and adviced to get hemodialysis done
From then on she was on hemodialysis twice weekly.
Now for the past 3 days she is complaining of high grade fever which was associated with chills and rigors and nausea , vomiting of 2 episodes non billions, non projectile, food as content
Not associated with pain abdomen or loose stools
PAST HISTORY :
K/c/o hypertension since 6 years
Not a known case of CAD, Asthma,TB, Epilepsy, Thyroid disorders.
No history of sugeries and blood transfusions in the past.
Patient is a vegetarian diet
Her life style has changed after undergoing dialysis as her appetite was decreased and she is not able to resume her works like working in the farm
There are similar complaints in the family (The patient's mother and sister had suffered from the similar condition).
No cancer deaths in the family.
On examination, patient is conscious, coherent, cooperative
She has Pallor.
No icterus, cyanosis, clubbing, lymphadenopathy, edema
VITALS:
Temperature - 99 F
BP - 100/50 mg
PR - 118 bpm
RR - 16 cpm
GRBS - 135 gm/dl
On systemic examination
CVS - S1, S2 heard, No murmurs
RS - Bilateral air entry present, normal vesicular breath sounds heard
Per Abdomen - soft , non tender and Bowel sounds heard
CNS - No focal neurological deficits
Provisional diagnosis :
Chronic kidney disease with k/c/o hypertension since 6years
Investigation :
RFT
Sr. Urea - 165
Sr. Creatinine- 12
Sr. Uric acid - 7.4
Sr. Calcium - 8.1
Sr. Sodium - 130
Sr. Potassium - 5.2
Sr. Urea - 165
Sr. Creatinine- 12
Sr. Uric acid - 7.4
Sr. Calcium - 8.1
Sr. Sodium - 130
Sr. Potassium - 5.2
CBP
Hb - 6.8 gm/dl
TLC - 4700 cells/cumm
Neutro - 95
Lympho - 3
Eosino - 1
Mono - 1
Basophils - 0
Platelet count - 1.55 lakh/cumm
ECG
USG
TREATMENT :
- Fluid (<2L/day) and salt restriction (<2gm/day)
- TAB. LASIX 40mg PO BD
- TAB. PCM 500mg PO
- TAB. OROFER- XT PO OD
- TAB. SHELCAL 500mg PO OD
- TAB. NODOSIS 500 mg PO OD
- TAB. NICARDIA 10mg PO BD
- BP and fever charting, inform SOS
