Ckd case

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57yr  old male patient farmer by occupation presented with cheif complaints of 

Bilateral lower limbs swelling associated with pain since 5 days

Decrease urine output since 5 days

Fever during dialysis since 2 days.

HOPI:

Patient was apparently alright 1 year back following which he developed bilateral lower limb swelling associated with shortness of breath, pain in flank and decreased urine output and fever then he visited local physcian where he was diagnosed with chronic renal failure and referred to nephrologist near by and started medical management for CKD.

Since then patient is on conservative management for CKD for 6 months. 

6 months back he developed sudden onset of shortnessof breath associated with generalised body swelling then he went to a nephrologist near by and hemodialysis was initiated through RT IJV. 10 sessions of hemodialysis was done and Patient was referred to NIMS for further evaluation.

Patient was hemodynamically stable when he consulted to nephrologist in NIMS and they advised to pause the dialysis and managed with medication for 1 month and removed central line.

As patient felt better and re-energise patient didn't follow up at NIMS for 4 months and started doing his routine farming.

2 months back patient developed similar episodes of SOB at rest and pedal edema and undergone dialysis at Osmania through permacath placed in Rt IJV.

Since then patient is on maintainance Hemodialysis.

Since 2 days patient having chills and fever during dialysis and hypotension.

Personal history :

Appetite : decreased 

Diet : mixed 

Sleep : adequate 

Bladder : decreased urine output

Bowel movements: regular 

Addictions :absent 

 

General examination:

Pallor: absent

Icterus: absent 

Cyanosis : absent 

Clubbing : absent 

Lymphadenopathy : absent 

Edema : present B/L pitting type of pedal edema

Vitals:

 Temperature: afebrile 

 Pulse: 119 bpm

 Blood pressure:140/80 mm of hg

 Respiratory rate : 28 bpm

SpO2 : 96 on RA

GRBS : 358 MG/DL

Systemic examination:

Cardiovascular system  

S1, S2 - heart sounds heard 

Pericardial rub - absent

Jvp is raised

ECG:

Respiratory system:

Patient examined in sitting position

Inspection:-

oral cavity- Normal ,nose- normal ,pharynx-normal 

Chest shape : Barrel

Trachea is central in position.

Palpation:-

All inspiratory findings are confirmed

Trachea central in position

Apical impulse in left 5th ICS, 

Chest movements bilaterally symmetrical 

AUSCULTATION 

Decreased air entry on Rt side 

B/L crepts present ( Rt >lt)

Abdomen examination:

INSPECTION

Shape : distended 

Umbilicus:normal 

Movements :normal

Visible pulsations :absent

Skin or surface of the abdomen : normal 

PERCUSSION- tympanic

AUSCULTATION :bowel sounds heard

USG : 

LABS:

FEVER CHART:

PROVISIONAL DIAGNOSIS:

CKD ON MHD(hepatic hemosiderosis in maintenance hemodialysis)

Treatment:

Iv paracetamol

28/06/22

On dialysis

Patient was stable and treatment is given 

29/06/22

Bp 110/80

Under treatment

Fever reduced 

29/06/22

Patient was discharged