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A CASE OF 45 yr old male with CKD on MHD (Second degree Diabetic nephropathy)

October 08, 2021

This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's 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.




CASE: A 45 yr old male presented with fever , burning micturition , pedal edema


CHIEF COMPLAINTS: fever 

Burning micturition 

Facial puffiness 

Pedal edema progresses to anasarca

5 sessions of Hemodialysis were done 


HISTORY OF PRESENTING ILLNESS: The patient has been readmitted to our hospital

first dialysis was done on 5/09/21

No h/o pedal edema , oliguria and SOB (from past 7 days)


HISTORY OF PAST ILLNESS: He is a known case of Diabetes mellitus (DM2) on medication ie. Actrapid 

Hypertension , on medication tab NICARDIA 20mg x PO x BD

tab METXL 25mg x PO x BD 

Hypothyroidism , on medication tab THYRONORM 50mg x PO x OD


PERSONAL HISTORY: Married 

Occupation - auto driver 

Appetite - Normal 

Bowel - Regular 

Micturition - Normal 


FAMILY HISTORY: No known case of 

Diabetes mellitus 

Hypertension 

Heart disease 

Stroke 

Cancer 

Asthma 


PHYSICAL EXAMINATION: 


Pallor - No 

Cyanosis - No 

Lymphadenopathy- No

Malnutrition - No

Dehydration - No 

Icterus - No 

Oedema - Yes 





VITALS 


Temperature - 98.4 Fahrenheit

Pulse rate 84/min

Respiration rate - 24/min

BP - 140/90

SPO2 - 98%

GRBS - 124 mg%


SYSTEMIC EXAMINATION 


CARDIOVASCULAR SYSTEM 


Thrills - No

Cardiac sounds - S1 and S2 are normal 

Cardiac murmurs - No 


RESPIRATORY SYSTEM 


Dyspnoea - No

Wheeze - No 

Position of trachea - Central 

Breath sounds - Normal 


PER ABDOMEN EXAMINATION 


Hernial orifices - Normal 

Free fluid - No

Bruits - No

Liver - Not palpable 

Spleen - Not palpable 

Bowel sounds - Yes 


CENTRAL NERVOUS SYSTEM


Level of consciousness - Consious 

Speech - Normal 

Signs of meningeal irritation - 

a)Neck stiffness: No 

b)Kerning’s sign : No

Cranial nerves - Normal 

Motor nerves - Normal 

Sensory nerves - Normal 


Reflexes - 

                     R        L

Biceps          +        +

Triceps.        +        +

Supinator     +        +

Knee            +        +

Ankle           +        +


CEREBRAL SIGNS 


Finger nose in - coordination - No

Knee heel in - coordination - No


GAIT 


PROVISIONAL DIAGNOSIS 


Chronic Kidney disease on Maintenance hemodialysis (Second degree Diabetic nephropathy)

K/C/O DM2 , HTN (2years) + Hypothyroidism (6 months)


TREATMENT HISTORY 


20/9/21


Rx 

  1. Fluid restriction <1.5L/day
  2. Salt restrictions <2gm/day
  3. Tab Lasix 40mg x PO x BD
  4. Tab NICARDIA 20mg x Pao x BD 
  5. Tab Met XL 25mg x PO x BD 
  6. Tab THYRONORM 50mg x Pao x OD
  7. Tab Livogen x PO x BD 
  8. Inj Actrapid x s/c
21/9/21

Rx 

  1. Fluid restriction <1.5L/day
  2. Salt restrictions <2gm/day
  3. Tab Lasix 40mg x PO x BD
  4. Tab NICARDIA 20mg x Pao x BD 
  5. Tab Met XL 25mg x PO x BD 
  6. Tab THYRONORM 50mg x Pao x OD
  7. Tab Livogen x PO x BD 
  8. Inj Actrapid x s/c
22/9/21

Rx

  1. Tab Taxim 20mg
  2. Tab Nicardia BD
  3. Tab THYRONORM 50mg OD 
  4. Tab Livoten BD
  5. Inj Actrapid 
  6. Tab Met XL 25mg
23/9/21

Rx
  1. Tab NICARDIA 20mg BD
  2. Tab Met XL BD
  3. Tab Lasix BD
  4. Tab Nodosis BD 
  5. Tab Thromen 50mg 
  6. Inj HAI s/c
24/9/21

Rx
  1. Fluid restriction <1.5L/day
  2. Salt restrictions <2gm/day
  3. Tab Lasix 40mg x PO x BD
  4. Tab NICARDIA 20mg x Pao x BD 
  5. Tab Met XL 25mg x PO x BD 
  6. Tab THYRONORM 50mg x Pao x OD
  7. Tab Urogen x PO x BD 
  8. Inj Actrapid x s/c
25/9/21

Rx
  1. Fluid restriction <1.5L/day
  2. Salt restrictions <2gm/day
  3. Tab Lasix 40mg x PO x BD
  4. Tab NICARDIA 20mg x Pao x BD 
  5. Tab Met XL 25mg x PO x BD 
  6. Tab THYRONORM 50mg x Pao x OD
  7. Tab Urogen x PO x BD 
  8. Inj Actrapid x s/c
29/9/21

Rx
  1. Fluid restriction <1.5L/day
  2. Salt restrictions <2gm/day
  3. Tab Lasix 40mg x PO x BD
  4. Tab NICARDIA 20mg x Pao x BD 
  5. Tab Met XL 25mg x PO x BD 
  6. Tab THYRONORM 50mg x Pao x OD
  7. Tab Livogen x PO x BD 
  8. Inj Actrapid x s/c
  9. Tab Cefixime 200mg x PO x BD 
  10. Sup Ascoril D 10 ml TID 
  11. Tab Shelcal OD
  12. Tab Pan 40 BD 
  13. Inj HAI 

30/9/21

Rx
  1. Tab Lasix 40mg x PO x BD
  2. Tab NICARDIA 20mg x Pao x BD 
  3. Tab Met XL 25mg x PO x BD 
  4. Tab THYRONORM 50mg x Pao x OD
  5. Tab Livogen x PO x BD 
  6. Inj Actrapid x s/c
  7. Tab Cefixime 200mg x PO x BD 
  8. Sup Ascoril D 10 ml TID 
1/10/21

Rx
  1. Fluid restriction <1.5L/day
  2. Salt restrictions <2gm/day
  3. Tab Lasix 40mg x PO x BD
  4. Tab NICARDIA 20mg x Pao x BD 
  5. Tab Met XL 25mg x PO x BD 
  6. Tab THYRONORM 50mg x Pao x OD
  7. Tab Urogen x PO x BD 
  8. Inj Actrapid x s/c
2/9/21

Rx
  1. Fluid restriction <1.5L/day
  2. Salt restrictions <2gm/day
  3. Tab Lasix 40mg x PO x BD
  4. Tab NICARDIA 20mg x Pao x BD 
  5. Tab Met XL 25mg x PO x BD 
  6. Tab THYRONORM 50mg x Pao x OD
  7. Tab Urogen x PO x BD 
  8. Inj Actrapid x s/c
5/9/21

Rx
  1. Inj Erythropoietin 

INVESTIGATION 

ECG 




USG 




HIV 1/2 rapid test 



HBsAg-RAPID 



ANTI HCV Antibodies



Complete urine examination 




Complete blood picture 




Blood grouping and RH type 




Serum iron 




Blood urea 



Serum creatinine 




Serum electrolyte 




Blood sugar random 









































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