A CASE OF CKD ON MHD

MEDICINE CASE DISCUSSION

This is an E-log book to discuss our patient's de-identified health data shared after taking his guardian's signed informed consent. Here we discuss our individual patient 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. This e-log book also reflects my patient centered online learning portfolio and your valuable comments in comment box are most welcomed .

I have been given this case, in an attempt to solve and understand the topic of "Patient's clinical data analysis”. This has helped me develop my competency in reading and comprehending clinical data including history taking, clinical findings and investigations. The goal is to come up with a diagnosis and treatment plan.  

75 year old male patient presented with CKD ON MHD

CHIEF COMPLAINTS:

Patient came with c/o
Abdominal distension since 20 days.
Swelling of B/L lower limbs since 20 days.

HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 20 days back when he developed abdominal distension which was insidious in onset and gradually progressive .It was associated with swelling of lower limbs upto knee joint on both sides.
Complaints of shortness of breath which was aggravated in supine position and relieved on sitting up(NYHA grade 4)
He also complaints of decreased frequency of urination since 20 days.
No c/o palpitations, cough, chest pain, syncopal attacks, PND.
No c/o abdominal pain, pruritis, hematuria, frothy urine.

For these symptoms he went to a local hospital and was treated with 6 rounds of hemodialysis.
The complaints relieved with treatment.
Since 4 days patient has been having vomiting (3 episodes /alternate day)with food as content.
He also has 5-7 episodes of loose stools daily which relieved with medication
Pruritis since 2 days

PAST HISTORY:
No similar complaints in the past
Not a k/c/o DM, HTN, asthma, thyroid disorder , epilepsy, CAD,CVA.

PERSONAL HISTORY:

He is farmer by occupation.

Diet- mixed

Appetite-decreased since the last 20 days

Sleep-adequate

Bowel-5-6 episodes of loose stools since 4 days

Bladder-decreased frequency since 20days

Allergies- none

Addictions:

Alcoholic since 60 years and consumes 180ml/day

Tobacco -consumes in the form of chewable since 60 years

FAMILY HISTORY:

No similar complaints in the family

GENERAL EXAMINATION:

Patient is consious, coherent and cooperative

Mild pallor present.

No  icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.

SYSTEMIC EXAMINATION: 

CVS: S1 and S2 heard. No added thrills or murmurs heard

RESPIRATORY SYSTEM:  

Normal vesicular breath sounds heard. 

ABDOMEN:

Soft and non-tender.

No organomegaly seen.

Mass per abdomen felt in the umbilical and epigastric region

umbilicus is inverted

CNS:

Conscious and coherent.

Normal sensory and motor responses.

INVESTIGATIONS:

ECG :

1/5/23:

 

3/5/23:

 

4/5/23

 

2D ECHO: (3/5/23)

PROVISIONAL DIAGNOSIS:

The patient is suffering from chronic kidney disease and is on maintenance hemodialysis with hyperkalemia secondary to renal failure with urosepsis(resolved) .

TREATMENT:

1-INJ.NORADRENALIN 2AMP +40MLNS @6 ML/HR TO MAINTAIN MAP >65MM OF HG

2-INJ SODIUM BICARBONATE 25MEQ/IV SLOW/STAT

3-INJ.MONOCEF 1GRAM IV/BD

4-INJ.LASIX 40MG IV/BD

5-TAB NODOSIS 100MG PO/BD

6-TAB BPO D3 PO/OD

7-TAB .SHELCAL PO/OD

8-FLUID RESTRICTION <1.5L/DAY

9-TAB OROFER -XT PO/OD

10-TAB VOMIKIND-MD PO/SOS

THEORY:

ON CKD