GENERAL MEDICINE CASE DISCUSSION

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A 46 year old man came to the casualty complaining of generalized swelling and shortness of breath since 2 days.

He was apparently asymptomatic six years ago, then he had an episode of fever for which was admitted to the hospital.

 He was diagnosed to have malaria.

He was diagnosed with Diabetes Mellitus as well.

Then, 3 years ago, he had an another episode of fever for which he consulted a physician which advised to underg

He was found to have Viral Pyrexia and was diagnosed with Hypertension.

Then around 1 year ago , one morning he had an episode of weakness of the right arm for which he was advised to undergo physiotherapy. 

Since then his fine motor function of the right arm is impaired. 

After 6 months of physiotherapy, the family thought he might get dependent on it so discountined.

On September 2nd 2021, he came to the casualty with complaints of generalised swelling and shortness of breath since 2 days.

He was diagnosed with Acute Kidney Injury with Serim Creatinine value being 9.

He is undergoing regular Hemodialysis since then.

His left hand has fistula.

His last dialysis was on 10 January, 2022.

Vitals :

Temperature - Afebrile

BP - 140/90mm Hg

PR - 89 bpm , regular

RR - 18/min

SpO2 - 99% at RA

On Examination :

CVS - S1 S2 present, no murmurs

RS - NVBS heard

PA - soft, non tender, obese with Abdominal distension

CNS - NAD

Investigations :

Hemogram :

Hb - 8.7 gm/dl

TLC - 7,600 cells/cubic mm

PCV - 26.2

MCV - 81.3

MCH - 26.9

RBC - 3.22

RFT :

Urea - 71 mg/dl

Creatinine - 5.6 mg/dl

Uric acid - 6.4 mg/dl

Na - 133

K - 3.9

Cl - 101

LFT :

TB - 0.7

DB - 0.2

SGOT - 14

SGPT - 19

ALP - 206

Albumin - 3.3

Serology - Negative

Ferritin - 197

Serum iron - 66

Provisional Diagnosis : CKD on MHD

Treatment :

1. Fluid restriction < 1litre/day

2. Salt restriction < 2.4 g/day

3. Tab NICARDIA 10mg PO/BD

4. Tab LASIX 40mg PO/BD

5. Tab SHELCAL PO/ OD

6. Tab OROFER XT PO/ OD

7. Tab DOLO 650mg PO/SOS

8. Tab NODOSIS 500mg PO/BD.