CKD PATIENT CASE
A 27 years old patient is being going through dialysis procedure due to his prior bilateral kidney failure two years back
Cheif Complaints
Patient experinced with vomiting regularly for 45 days continously, 2 years back. At that time he also noticed that he has Oedema around his both ankles and he has also difficulty on walking normally.
History of presenting illness.
He has pedal oedema bilaterally of pitting type, after check up with his first doctor he had been recommended to an nephrologist due to his illness in related to kidney disease
On checkup he had been diagnosed with bilateral kidney failure 2 year back and also a known case of tuberculosis on urine examination 5 months ago, but on after consecutive urine examination the tuberculosis is found to be negative.
Past history
* * patient had continuous vomiting episodes for 45 days 2 years back
** patient had p.edal oedema specifically around ankles and now also he has pitting type of pedal edema
** patient is also a known case of tuberculosis and been on ATT medial regimen.
**during his first visit to a normal medical centre he has been diagnosed hypertensive and also been referred to an nephrologist
**he was diagnosed as a CKD patient and been admitted for dialysis procedure 2 years back
**from then he is been having dialysis since 2 years (weekly once or twice)
** Also no history of previous surgeries.
Family history
His family members are not having any relevant issues.
also no history of hypertension or Diabetes etc .
No history of cancers , TB, asthma, etc.
Treatment history
He is known case of hypertension, So is being taking anti hypertensive drugs.
Nicardia 20mg
Metexel 50mg
Arkamin 0.5mg
Lasix 40mg
ATT DRUGS for TUBERCULOSIS
PERSONAL HISTORY
DIET - mixed diet
APPETITE - normal appetite
ADDICTIONS - no addictions like smoking and alcohol
SLEEP - normal
ALLERGIES - no significant allergies
BOWEL AND BLADDER - normal bowel but decreased urine output (250ml-300ml)
GENERAL EXAMINATION
During General examination patient is conscious, coherent and co-operative
Patient is well built and well nourished
PALLOR - positive
CYANOSIS - negative
ICTERUS - negative
CLUBBING - negative
LYMPHADENOPATHY - no generalised lymphadenopathy
OEDEMA - positive (pitting type)
VITALS
temperature afebrile
pulse - 86 bpm
RR - 14 cpm
BP - 130/80 mmHg
SPO2 - 98 percent at room air
SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM - S1 S2 are positive
RESPIRATORY SYSTEM -
no dyspnoea
no wheezing
Trachea position is central
vesicular breath sounds
ABDOMEN
Shape is scaphoid
non tender abdomen
no palpable mass
normal hernial orifices
liver is not palpable
spleen is not palpable
no bowel sounds can be heard
CENTRAL NERVOUS SYSTEM
Conscious and alert
speech is normal
No neck stiffness and no kerning’s sign( no sign of meningitis)
cranial nerves, motor system, sensory system , Glasgow scale all are intact
REFLEXES - normal reflexes
CEREBRAL SIGNS
No finger-nose in-coordination
No kneel-heel in-coordination
GAIT - normal
MUSCULOSKELETAL SYSTEM - normal
EXAMINATION OF ENT - normal
EXAMINATION OF TEETH AND ORAL CAVITY - normal
EXAMINATION OF HEAD AND NECK - normal
PROVISIONAL DIAGNOSIS - CKD on MHD
INVESTIGATIONS
COMPLETE BLOOD PICTURE -
 |
COMPLETE URINE EXAMINATION
SERUM IRON
LFT
ECG
USG
TREATMENT
tab LASIX 40mg BD
tab NODOSIS 500 mg BD
tab SHELCAL OD
tab OROFER BD
tab PANTOP 40 mg OD
Inj ERYTHROPOIETIN 4000IU once weekly
Inj IRON SUCROSE 100mg once weekly
tab NICARDIA 20 mg BD
On anti tubercular drugs since 5 months
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