A CASE OF CHRONIC RENAL FAILURE PRESENTED IN SUMMER 2022
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A 65 years old lady farmer by occupation presented in the casualty with complaints of shortness of breath and pedal edema.
CHIEF COMPLAINTs
➤SOB for last 4 days
➤Cough for last 4 days
➤Pain in lower limb for last 4 days
HISTORY OF PRESENTING ILLNESS
Patient was apparently asymptomatic 4 months back. In April , She had SOB on exertion with tingling sensation in both upper and lower arms, pedal edema and decrease in urine output ( creatinine : 3.1mg/dl )for which she got treated in nearby hospital and her symptoms got resolved. Again by end of June She had nausea , vomiting ,weakness ,burning micturition and pain in lower limb (creatinine : 3.8mg/dl uric acid:5.6mg/dl) for which she was treated and all her complains got resolved .In July she presented with pain in lower limbs ( creatinine : 5.2mg/dl uric acid:6.4mg/dl)for which she got treated and symptoms got resolved.
In mid of august she came to our hospital with complaints of SOB for past 4 days which is of grade II . It is associated with cough with expectorant. She is also having pain in both lower limb from knee to toes only on movement for past 4 days. Pain is of non radiating type. She works as a cotton picker and experience pain even in bending down to pick cottons.No redness and tenderness present at or around joints.Not having feverNo abdominal painNo back ache.
HISTORY OF PAST ILLNESS ➤Not a known case of diabetes ,bronchial asthma ,epilepsy, tuberculosis
➤k/c/o hypertension for 8 years
DRUG HISTORY
➤Tab Atenolol 50mg OD for HTN for last 8 years
PERSONAL HISTORY
➤ Occupation : Farmer
➤Patient is married
➤Patient takes mixed diet but has a decreased appetite.
➤Bowel and bladder movement is normal and regular.
➤No addiction
FAMILY HISTORY
➤No significant family history.
GENERAL EXAMINATION
➤Pallor :Not seen
➤Icterus : Not seen
➤Cyanosis : Not seen
➤Clubbing : Not seen
➤Lymphadenopathy : Not seen
➤Edema : Not seen
VITALS
➤Temperature : 98.3℉
➤PR : 76 beats per minute
➤BP : 130/80 mm of Hg
➤RR : 18 cycles per minute
➤SpO2 : 97% in room air
➤Blood Sugar (random) : 119mg/dl
SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM EXAMINATION
➤s1 and s2 heard
➤Thrills absent.,
➤No cardiac murmurs
RESPIRATORY SYSTEM
➤Normal vesicular breath sounds heard.
➤Bilateral air entry present
➤Trachea is in midline
ABDOMINAL EXAMINATION
INSPECTION
➤Shape - Scaphoid
➤Equal movements in all the quadrants.
➤No visible pulsation, dilated veins and localized swellings.
PALPATION
➤No tenderness
➤No palpable mass
CENTRAL NERVOUS SYSTEM EXAMINATION
➤Conscious and coherent
PROVISIONAL DIAGNOSIS : CHRONIC RENAL FAILUE
DAY 1
INVESTIGATIONS :
1) COMPLETE BLOOD PICTURE
2) RFT
BLOOD UREA 158 mg/dl
CREATININE 6.2 mg/dl
3)USG ABDOMEN
4) SERUM IRON 73ug/dl
TREATMENT
1) TAB. NICARDIA PO/OD
2)TAB NODOSIS
3)TAB SHELCAL 500mg PO/OD
4)TAB OROFER XT PO/OD
5)CAP BI0 D3 PO/OD WEEKLY ONCE
6)INJ. ERYTHROOIETIN 4000IU S/C TWICE WEEKLY
7)INJ. PANTOP 40MG
8)INJ.ZOFER
DAY 2TREATMENT
1) TAB. NICARDIA PO/OD
2)TAB NODOSIS
3)TAB SHELCAL 500mg PO/OD
4)TAB OROFER XT PO/OD
5)CAP BI0 D3 PO/OD WEEKLY ONCE
6)INJ. ERYTHROOIETIN 4000IU S/C TWICE WEEKLY
7)INJ. PANTOP 40MG
8)INJ.ZOFER
DAY 3TREATMENT
1) TAB. NICARDIA PO/OD
2)TAB NODOSIS
3)TAB SHELCAL 500mg PO/OD
4)TAB OROFER XT PO/OD
5)INJ. ERYTHROOIETIN 4000IU S/C TWICE WEEKLY
Dialysis started at 10 pm & ended at 12 am
Weight loss-500gm
➤Not a known case of diabetes ,bronchial asthma ,epilepsy, tuberculosis
➤k/c/o hypertension for 8 years
DRUG HISTORY
➤Tab Atenolol 50mg OD for HTN for last 8 years
PERSONAL HISTORY
➤ Occupation : Farmer
➤Patient is married
➤Patient takes mixed diet but has a decreased appetite.
➤Bowel and bladder movement is normal and regular.
➤No addiction
FAMILY HISTORY
➤No significant family history.
GENERAL EXAMINATION
➤Pallor :Not seen
➤Icterus : Not seen
➤Cyanosis : Not seen
➤Clubbing : Not seen
➤Lymphadenopathy : Not seen
➤Edema : Not seen
VITALS
➤Temperature : 98.3℉
➤PR : 76 beats per minute
➤BP : 130/80 mm of Hg
➤RR : 18 cycles per minute
➤SpO2 : 97% in room air
➤Blood Sugar (random) : 119mg/dl
SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM EXAMINATION
➤s1 and s2 heard
➤Thrills absent.,
➤No cardiac murmurs
RESPIRATORY SYSTEM
➤Normal vesicular breath sounds heard.
➤Bilateral air entry present
➤Trachea is in midline
ABDOMINAL EXAMINATION
INSPECTION
➤Shape - Scaphoid
➤Equal movements in all the quadrants.
➤No visible pulsation, dilated veins and localized swellings.
PALPATION
➤No tenderness
➤No palpable mass
CENTRAL NERVOUS SYSTEM EXAMINATION
➤Conscious and coherent
PROVISIONAL DIAGNOSIS : CHRONIC RENAL FAILUE
DAY 1
INVESTIGATIONS :
1) COMPLETE BLOOD PICTURE
2) RFT
|
| BLOOD UREA 158 mg/dl |
|
| CREATININE 6.2 mg/dl |
TREATMENT
1) TAB. NICARDIA PO/OD
2)TAB NODOSIS
3)TAB SHELCAL 500mg PO/OD
4)TAB OROFER XT PO/OD
5)CAP BI0 D3 PO/OD WEEKLY ONCE
6)INJ. ERYTHROOIETIN 4000IU S/C TWICE WEEKLY
7)INJ. PANTOP 40MG
8)INJ.ZOFER
TREATMENT
1) TAB. NICARDIA PO/OD
2)TAB NODOSIS
3)TAB SHELCAL 500mg PO/OD
4)TAB OROFER XT PO/OD
5)CAP BI0 D3 PO/OD WEEKLY ONCE
6)INJ. ERYTHROOIETIN 4000IU S/C TWICE WEEKLY
7)INJ. PANTOP 40MG
8)INJ.ZOFER
TREATMENT
1) TAB. NICARDIA PO/OD
2)TAB NODOSIS
3)TAB SHELCAL 500mg PO/OD
4)TAB OROFER XT PO/OD
5)INJ. ERYTHROOIETIN 4000IU S/C TWICE WEEKLY
Dialysis started at 10 pm & ended at 12 am
Weight loss-500gm
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