62 year old female with CKD on MHD

A 62 year old female patient who is a daily wage labourer  by occupation came to the OPD with a chief complaint of pedal edema, decreased urinary output and shortness of breath since 4 days

HISTORY OF PRESENT ILLNESS

She was asymptomatic 7 years ago then she
had giddiness and fever. she went to local RMP and was diagnosed as Hypertension and started on medication  (Tab Atenolol 50 mg bd) 

1 year back she developed Pedal edema  , Facial puffiness and abdominal distension for which she visited the same RMP and she was told that these symptoms were due to hypertension and advised to continue same antihypertensives
4 months back in  april 2021 She went to Suryapet as she was having sob grade 4 and pedal edema and abdominal distension with fascial puffiness  when ultrasound was done and diagnosed with underlying Kidney disease and was reffered to our institute.
she also has decreased appetite 4 months back 


The patient was shifted to Amc from dialysis due to complaints of SOB, Sweating

Series of events 

The patient was undergoing dialysis and had blood pressure of 210/130 mm Hg
Nicardia 20mg ans Arkamin 0.1 mg were administered stat
Then Bp hasn't reduced 
So lasix 80 mg and labetolol 10mg 
The Bp reduced to 170/110 mm Hg
Then labetolol 10mg was administered
Bp recorded was 160/110 mm Hg
After half an hour Bp was 140/90 mm Hg
Nitroglycerin was given 
Patient was stabilized
 
The patient also had shortness of breath
Stats were 80%
 
BiPAP was done and Sats increased to  90%
But ABG showed mild acidosis
The patient stabilized after 2 hours BiPAP and then was put on Oxygen


PAST HISTORY
She's a HTN 7 years was on medication.
No K/C/O  DM, CAD, ASTHMA, TB, EPILEPSY

On Examination

Pt is C/c/c
Temp-Afebrile
Bp - 140/90 mm Hg
PR - 84 bpm
Rr - 22 cpm
SpO2 - 94% at RA
GRBS - 102 mg/dl

CVS - S1 S2+
RS - BAE+
P/A - soft, non tender 
BS +


PROVISIONAL DIAGNOSIS - CHRONIC KIDNEY DISEASE ON MHD with HTN

3 blood transfusions were done on 28/9, 6/10, 16/10/21 respectively.

 Pt is on HEMODIALYSIS, 3 Sessions were done on 21/9, 6/10, 11/10/21 respectively.

Investigations

Serology negative 
Rt-Pcr negative


TREATMENT GIVEN

1. Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB LIVOGEN /PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD


DAY 2
Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB LIVOGEN /PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD


DAY 3

Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB LIVOGEN /PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD
Nebulization  with Budecort 8th hrly
 Duolin 6th hrly


DAY 4
Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
INJ AUGMENTIN 1.2GM IV/BD( DAY 1)
INJ LEVOFLOXACIN 500MG IV/OD ( DAY 1)
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB OROFER XT/PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD
Nebulization IPRAVENT - 6HRLY
     BUDECORT 8TH HRLY

DAY 5
Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
INJ AUGMENTIN 1.2GM IV/BD( DAY 2)
INJ LEVOFLOXACIN 500MG IV/OD ( DAY 2)
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB OROFER XT/PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD
Nebulization IPRAVENT - 6HRLY
     BUDECORT 8TH HRLY

DAY 6 
Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
INJ AUGMENTIN 1.2GM IV/BD( DAY 3)
INJ LEVOFLOXACIN 500MG IV/OD ( DAY 3)
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB OROFER XT/PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD
Nebulization IPRAVENT - 6HRLY
     BUDECORT 8TH HRLY

DAY 7
Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
INJ AUGMENTIN 1.2GM IV/BD( DAY 4)
INJ LEVOFLOXACIN 500MG IV/OD ( DAY 4)
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB OROFER XT/PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD
Nebulization IPRAVENT - 6HRLY
     BUDECORT 8TH HRLY

DAY 8
Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
INJ AUGMENTIN 1.2GM IV/BD( DAY 5)
INJ LEVOFLOXACIN 500MG IV/OD ( DAY 5)
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB OROFER XT/PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD
Nebulization IPRAVENT - 6HRLY
     BUDECORT 8TH HRLY
 
DAY 9
Fluid restriction < 1.5L/day
Salt restriction < 2gm/day
INJ AUGMENTIN 1.2GM IV/BD( DAY 6)
INJ LEVOFLOXACIN 500MG IV/OD ( DAY 6)
Tab LASIX 40mg / PO/OD
TAB NICARDIA 20mg/PO/BD
TAB OROFER XT/PO/BD
TAB NODOSIS 500mg/PO/BD
TAB Bio D3 0.25mcg /PO/BD
Nebulization IPRAVENT - 6HRLY
     BUDECORT 8TH HRLY


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