Case 20 85 Female

Doa 27/2/24

Dod

Diagnosis

CHRONIC RENAL FAILURE SECONDARY TO DIABETIC NEPHROPATHY

LEFT DISTAL TIBIA PLATING WITHOUT DNVD

K/C/O DIABETES MELLITUS

K/C/O HYPERTENSION

K/C/O CKD

Case History and Clinical Findings

PATIENT CAME WITH C/O REDNESS AND ITCHING OVER LEFT FOOT AND LEG SINCE 3 DAYS

SLAB WAS REMOVED- SKIN EXCORIATION PRESENT

SLAB CARE NOT TAKEN PROPERLY AND SLAB HYGEINE WAS NOT MAINTAINED

PATIENT IS K/C/O DMT2 ON MEDICATION INJ.HAI 6U-6U-6U

K/C/O HTN ON T.CLINIDIPINE 10MG PO OD

N/K/C/O ASTHMA,COPD,TB,EPILEPSY AND THYRIOD DIORDERS

GENERAL EXAMINATION

PATIENT IS C/C/C

NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY AND PEDAL EDEMA

TEMP - AFEBRILE

PR- 96 BPM

BP - 120/80 MM HG

CVS- S1S2 HEARD ,NO MURMURS

RS - BILATERAL AIR ENTRY PRESENT

P/A - SOFT,NON TENDER,NO ORGANOMEGALY

CNS - NFND

CASE WAS THEN TRANSFERRED TO NEPHROLOGY I/V/O DERANGED RFT

AFTER TRANSFERRING TO NEPHROLOGY PATIENT WAS INITIATED ON HEMODIALYSIS IN

VIEW OF DERANGED RENAL PARAMETERS

DURING FIRST SESSION OF HEMODIALYSIS PATIENT DEVELOPED HYPOTENSION DURING

DIALYSIS AND DIALYSIS WAS STOPPED AND NORADRENALINE INFUSION WAS STARTED

AND CONTINUED TO MAINTAIN MAP>65MM HG.

SECOND SESSION OF DIALYSIS WAS UNEVENTFUL AND NORADRENALINE INFUSION WAS

CONTINUED.

AGAIN DURING THIRD SESSION OF DIALYSIS PATIENT DEVELOPED HYPOTENSION AND

NORADRENALINE INFUSION WAS INCREASED AND CONTINUED HEMODIALYSIS BUT HER

HYPOTENSION DIDNOT GET RELIEVED AND DIALYSIS WAS STOPPED.

PATIENT WAS ADVISED FOR FOLLOW UP FOR FURTHER SESSIONS OF HEMODIALYSIS AND

DISCHARGED.

Investigation

HEMOGRAM 28/2/24

HB-11.6

TLC-6300

PLT-1.50

HEMOGRAM 2/3/24

HB-10.6

TLC-8500

PLT-1.69

HEMOGRAM 3/3/24

HB-10.4

TLC-8400

PLT-1.51

HEMOGRAM 4/3/24

HB-9.2

TLC-14000

PLT-92000

BLOOD UREA 27-02-2024 03:39:PM 338 mg/dl

SERUM CREATININE 27-02-2024 03:39:PM 11.3 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 27-02-2024 03:39:PM

SODIUM 141 mEq/L

POTASSIUM 4.8 mEq/L

CHLORIDE 100 mEq/L

LIVER FUNCTION TEST (LFT) 27-02-2024 03:39:PM

Total Bilurubin 3.15 mg/dl

Direct Bilurubin 0.46 mg/dl

SGOT(AST) 10 IU/L

SGPT(ALT) 10 IU/L

ALKALINE PHOSPHATASE 129 IU/L

TOTAL PROTEINS 7.2 gm/dl

ALBUMIN 2.9 gm/dl

A/G RATIO 0.69

COMPLETE BLOOD PICTURE (CBP) 27-02-2024 03:39:PM

HAEMOGLOBIN 10.5 gm/dl

TOTAL COUNT 7200 cells/cumm

NEUTROPHILS 57 %

LYMPHOCYTES 33 %

EOSINOPHILS 01 %

MONOCYTES 09 %

BASOPHILS 00 %

PLATELET COUNT 2.07

SMEAR Normocytic normochromic anemia.

HBsAg-RAPID 27-02-2024 03:39:PM Negative

Anti HCV Antibodies - RAPID 27-02-2024 03:39:PM Non Reactive

RFT 28-02-2024 12:46:AM

UREA 334 mg/dl

CREATININE 10.8 mg/dl

URIC ACID 12.0 mg/dl

CALCIUM 9.4 mg/dl

PHOSPHOROUS 5.5 mg/dl

SODIUM 138 mEq/L

POTASSIUM 4.9 mEq/L

CHLORIDE 100 mEq/L

ABG 28-02-2024 12:47:AM

PH 7.49

PCO2 19.7

PO2 117

HCO3 15.0

St.HCO3 18.9

BEB -6.8

BEecf -7.8

TCO2 30.8

O2 Sat 96.7

O2 Count 13.3

COMPLETE BLOOD PICTURE (CBP) 29-02-2024 12:29:AM

HAEMOGLOBIN 11.6 gm/dl

TOTAL COUNT 6300 cells/cumm

NEUTROPHILS 51 %

LYMPHOCYTES 37 %

EOSINOPHILS 02 %

MONOCYTES 10 %

BASOPHILS 00 %

PLATELET COUNT 2.20

SMEAR Normocytic normochromic blood picture

RFT 29-02-2024 12:29:AM

UREA 364 mg/dl

CREATININE 10.0 mg/dl

URIC ACID 11.6 mg/dl

CALCIUM 10.0 mg/dl

PHOSPHOROUS 5.3 mg/dl

SODIUM 142 mEq/L

POTASSIUM 5.4 mEq/L

CHLORIDE 103 mEq/L

COMPLETE BLOOD PICTURE (CBP) 29-02-2024 11:36:PM

HAEMOGLOBIN 11.3 gm/dl

TOTAL COUNT 7400 cells/cumm

NEUTROPHILS 79 %

LYMPHOCYTES 10 %

EOSINOPHILS 02 %

MONOCYTES 09 %

BASOPHILS 00 %

PLATELET COUNT 2.19

SMEAR Normocytic normochromic Anemia

ABG 29-02-2024 11:36:PM

PH 7.376

PCO2 16.1

PO2 133

HCO3 9.2

St.HCO3 13.4

BEB -14.4

BEecf -15.3

TCO2 19.1

O2 Sat 97.3

O2 Count 14.5

RFT 29-02-2024 11:36:PM

UREA 274 mg/dl

CREATININE 8.1 mg/dl

URIC ACID 8.2 mg/dl

CALCIUM 9.9 mg/dl

PHOSPHOROUS 4.4 mg/dl

SODIUM 145 mEq/L

POTASSIUM 4.5 mEq/L

CHLORIDE 106 mEq/L

RFT 02-03-2024 04:12:AM

UREA 274 mg/dl

CREATININE 8.1 mg/dl

URIC ACID 8.6 mg/dl

CALCIUM 10.1 mg/dl

PHOSPHOROUS 3.2 mg/dl

SODIUM 147 mEq/L

POTASSIUM 4.3 mEq/L

CHLORIDE 105 mEq/L

RFT 03-03-2024 12:05:AM

UREA 159 mg/dl

CREATININE 5.1 mg/dl

URIC ACID 4.9 mg/dl

CALCIUM 9.2 mg/dl

PHOSPHOROUS 2.9 mg/dl

SODIUM 149 mEq/L

POTASSIUM 3.7 mEq/L

CHLORIDE 104 mEq/L

RFT 4/3/24

UREA 179 mg/dl

CREATININE 5.2 mg/dl

URIC ACID 4.0 mg/dl

CALCIUM 10.0 mg/dl

PHOSPHOROUS 2.0 mg/dl

SODIUM 147 mEq/L

POTASSIUM 3.9 mEq/L

CHLORIDE 105 mEq/L

USG ABDOMEN AND PELVIS

B/L KIDNEYS SHOW DECREASED SIZE AND GRADE II -III RPD CHANGES

2D ECHO SHOWED

TRIVIAL MR +,NO MR/AR

NO RWMA.NO MS/AS.SCLEROTIC AV

EF 60%

GOOD LV SYTOLIC FUNCTION

GRADE II DIASTOLIC DYSFUNCTION +.NO PAH/PE

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION LESS THAN 1.5 L/DAY

SALT RESTRICTION LESS THAN 2-3 G/DAY

INJ.NORADRENALINE INFUSION @ 7 ML/HR(INCREASE/DECRTEASE TO MAINTAIN MAP LESS

THAN 65 MM HG)

IN.HAI S/C TID

TAB.NODOSIS 500 MG PO OD

TAB.SHELCAL 500 MG PO OD

TAB.OROFER XT PO OD

NEB WITH SALBUTAMOL 8TH HRLY

STRICT I/O CHARTING

Advice at Discharge

FLUID RESTRICTION LESS THAN 1.5 L/DAY

SALT RESTRICTION LESS THAN 2-3 G/DAY

IN.HAI S/C TID 6U - 6U - 6U

INJ EPO 4000IU S/C ONCE A WEEK

TAB.NODOSIS 500 MG PO OD

TAB.SHELCAL 500 MG PO OD

TAB.OROFER XT PO OD

TAB LASIX 40MG PO BD

Follow Up in may 2024

FBS 167 mg/dl PLBS 179 mg/dl Hba1C 7%

Follow up in february 2025

FBS 110mg/dl

PLBS 134

Hba1C 6.9%