CKD WITH HTN ON MHD

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


This E log book also reflects my patient-centered online 
learning portfolio and your valuable inputs on the comment box is welcome.

 HISTORY OF PRESENTING ILLNESS:
                                                                                                     A 65 yr old female from kodada whose was apparently asymptomatic 4 yrs back went to kodada government hospital with complaints of dizziness and diagnosed with hypertension(BP : 200/ ) and using medications from then
1 year later she developed anasarca and came to our hospital where she diagnosed with kidney failure (creatinine:3.0) and is on medical management from then.
She is alright with those medications until she stopped those medicines in june 2020 due to lockdown.
Then she developed anasarca and presented to our hospital with creatinine 13 and medical management was tried
Later in july she attended a marriage and had mutton and drink
Next day she developed anasarca , involuntary movement , altered sensorium and decreased urine output and presented to our causality
Then 4 dialysis were done and she is on MHD from then.
She had on and off SOB and persistent cough from then
Now patient again came to hospital on last saturday with complaints of anasarca and SOB and she is on dialysis

PAST HISTORY :- HTN since 4yrs
She had loss of sensation over right hand wrist and distal half of forearm and flexion deformity of middle finger ring finger and little finger of right hand  20 yrs and used some medication for 3 yrs at that time and stopped the medication because docter told them that the disease progression had halted.
Most likely leprosy

Not a k/c/o DM , Asthma , Epilepsy , CAD , TB

PERSONAL HISTORY:
Diet:Mixed
Sleep:Adequate
Appetite:Decreased
Bowel:Normal
Bladder:Decreased output

GENERAL EXAMINATION:
Patient is conscious,coherent,cooperative.
Moderately built and moderately nourished.
Pallor-Yes
Icterus-No
Cyanosis-No
Clubbing-No
Kilonychia-No
Lymphadenopathy-No
Edema-Anasarca present.
 On examination:
 Flexion deformity of middle,ring finger and little finger of right hand with wrinkling of skin over dorsum of right hand.
 
VITALS:
Temperature:Afebrile
BP: 150/100 mm Hg right side sitting position
PR:92bpm ,regular in rhythm,normal in volume
Rr:30cpm

SYSTEMIC EXAMINATION:
CVS: S1,S2 heard,no murmurs heard.
RS: BAE+ NVBS:+ve,Inspiratory crepts + in Rt side
P/A: Soft,nontender
CNS: Motor system: Normal
          Sensory system:Loss of sensation over right hand wrist and distal forearm.

INVESTIGATION:






DIAGNOSIS:Chronic Renal Failure on Maintaince Hemodialysis with K/C/O HTN with Right lower lobe Pneumonia.
TREATMENT:
   1. Inj.Piptaz 2.25gm IV/TID
            2.Inj.Pan 40mg IV/OD
            3.Inj.Lasix 40mg/IV/OD
            4.Tab.Nicardia 10mg/TID
            5.Tab.PCM 650mg/SOS
            6.Salt restriction <2.5gm/day and fluid                    restriction<1.5litres/day 
             7.Tab.Shelcal 500mg/OD
             8.Tab.Nodosis 550mg/BD
             9.BP/PR/Temp charting
             10.Strict I/O charting
              11.Nebulization with Budecort 8th hourly



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