A 53yr old female patient complaints of SOB
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A 53yr old female resident of basireddypally,daily wage worker by occupation came to our hospital with complaints of shortness of breath,decreased urine output and weakness since 6months
HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic 10years back.
As per the patient she suffered from severe backpain,breathlessness and weakness.Then she consulted a doctor in Hyderabad and he diagnosed her as chronic kidney disease
She was on medication from past 10years which were prescribed by the doctor
6months back she noticed decreased urine output and shortness of breath.Then she visited our hospital and was admitted into dialysis ward.She was on dialysis since 6months once in 3days.After dialysis patient complaints of fever with chills.
PAST HISTORY
She is a known case of hypertension since 10years.she is on medication since 10years.she has 4 vaginal deliveries and tubectomised 25years back
PERSONAL HISTORY
She is a vegetarian from 10years
Bowel and bladder movements-irregular
Inadequate sleep
No addictions
FAMILY HISTORY
No relevant family history
GENERAL EXAMINATION
Patient was conscious,coherent and cooperative
Moderately built
Pallor -present
No cyanosis
Clubbing-present
No generalized lymphadenopathy
No icterus
No bipedal edema
Vitals
Temperature-98.6°F
Respiratory rate-18cycles/min
Pulse rate-75beats/min
BP-120/80mm Hg
SYSTEMIC EXAMINATION
CVS
S1 S2 heard
Respiratory system
Bae present,no abnormalities
CNS
No focal neurological deficits
PROVISIONAL DIAGNOSIS
Chronic kidney Disease
INVESTIGATIONS
Urine protein/creatinine ratio
Hemogram
Serum amylase
RFT
Complete Blood Picture
Urinary chloride
Urinary potassium
Urine sodium
Serum electrolytes
Serum creatinine
Blood urea
ECG
TREATMENT
1.Salt and fluid restrictions
(<2g/day) (<1ltr/day)
2.Tab.Lasix 40mg PO/BD
3.Tab.Shelcal 500mg PO/OD
4.Tab.Orofer-XT PO/OD
5.Tab.Nodosis 550mg PO/OD
6.Tab.Nicardia 10mg PO/BD
7.Injection Erythropoietin 4000 IV weekly twice(post dialysis)
QUESTIONS:
1.Why pedal edema is absent in this patient?
2.How antihypertensive drugs has an effect on kidney?
3.Patient is a known case of CKD since 10 years .But why she is on dialysis from 6months only?
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