A 40 YR FEMALE WITH CKD ON MHD

 This is 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 patients clinical problems with collective current best evidence based inputsThis e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome.

Hyndavi Konakanchi, Intern

23/12/22

A CASE DISCUSSION 40/F CASE WITH CKD ON MHD

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

Following is the view of my case : 

A 40 yr old female who is apparently asymptomatic 4 yrs back and then one fine day when she was doing her work in their shop; she developed giddiness and went to local RMP in cheruvugattu ; there she was diagnosed to have blood pressure of around 160-170 ( diagnosed for the first time as hypertension)

So from then she used medication for 2 months — but there is no regular BP checkups in between 

And again on fine day when she was doing work in their shop, Developed giddiness again ; this time she went to a hospital in Nalgonda— there she was diagnosed to have kidney failure ; he advised some medications — she began using them and continued till now

On 13/12/22 ; when she was doing household activities,,Developed giddiness , B/L pedal oedema,SOB grade 4 , vomiting even after eating anything , she went to HYDERABAD YASHODA HOSPITAL — There doctors advised dialysis

1st dialysis was done on 14/12/22

2nd dialysis was done on 16/12/22 and discharged; doctors advised weekly 3 times dialysis, which can be done anywhere on day care basis, ,So came to our hospital for dialysis as it is near to their home in cheruvugattu

COMING TO HER DAILY ROUTINE: She is a shopkeeper by occupation

She wakes up at 5 am in the morning — freshen up & does house hold activities and go to work

By 8 am in the morning she goes to their shop along with lunch box

She returns home by around 6 pm in the evening

She does some household activities and freshen up and eat dinner and sleep by 10 pm

But from 2 yrs she stopped going to work as she is unable to do work in the shop But did household work slowly in the day

She eats rice and curry in the morning, afternoon, night ( 3 times a day )

But after she was diagnosed to have kidney failure in nalgonda ; she started to consume food which is less salty,spicy,oily and decreased water intake

MEDICAL HISTORY:

* She is under medication ( MET XL - metoprolol) from 4 years 

Not a K/C/O DM/ asthma / Ischemic heart disease / epilepsy / TB

FAMILY HISTORY

No significant family history 

PERSONAL HISTORY 

OCCUPATION : Shop keeper 

DIET : Mixed 

APPETITE : Normal 

SLEEP : Normal

BOWEL AND BLADDER HABITS : Normal

ADDICTIONS: No

GENERAL EXAMINATION 

* Patient is concious coherent and coperative, well oriented to time palce and person

* Built - moderately built , moderately nourished 

VITALS 

Blood pressure : 180/100 mm hg

Pulse Rate : 92 bpm

Temperature  : 98.6 degrees  F

SPO2 : 98 @ RA

GRBS : 102

PALLOR : PRESENT 

* NO ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY 

                  

                        

SYSTEMIC EXAMINATION

CVS EXAMINATION

Inspection- 

* The chest wall is bilaterally symmetrical

* No raised JVP.

Palpation-

* Apical impulse is felt in the left 5th intercostal space,  medial to the midclavicular line

* No parasternal heave felt.

Percussion-*resonant note heard-  no pericardial effusion

Auscultation-

## Mitral area , aortic area , pulmonary area 

* S1 and S2 heard, no added thrills and murmurs are heard

PER ABDOMINAL EXAMINATION :- 

Inspection:

* Abdomen is distended

* Umbilicus is inverted

Movements :

 * Gentle rise in abdominal wall in inspiration and fall during expiration. 

* No visible gastric peristalsis 

palpation : 

* SOFT, NON TENDER, NO ORGANOMEGALY

Percussion: 

Resonant note heard

No fluid (ascitis) 

Auscultation:

* Normal bowel sounds.

RESPIRATORY SYSTEM EXAMINATION :-

Inspection-

* Upper respiratory tract - Normal

* Shape of chest - elliptical & Bilaterally symmetrical 

* Trachea- in midline

* no scars and sinuses

* no visible pulsations

* no engorged veins

* no usage of accessory respiratory muscles

Palpation-

* No local rise of temperature

* No tenderness

* All the inspectory findings are confirmed 

* Apical Impulse :- 5th intercostal space 1 cm medial to mid clavicular line

* Trachea is in normal position. 

* chest expansion - normal.

* Movements of chest with respiration are normal.

 vocal fremitus - normal.

                     

Ausclutation-

* Bilateral air entry - present.

* Normal vesicular breathsounds are heard.

* No advantitious sounds heard.

CNS EXAMINATION :- 

* No focal neurological deficits 

* Higher motor functions are normal 

DIAGNOSIS : 

CKD ON MHD WITN HTN 

TREATMENT: 

1) TAB.MET XL 25 MG PO /OD

2) TAB.NICARDIA 10 MG PO/TID

3) TAB.NODOSIS 500 MG PO/BD 

4) TAB.SHELCAL 100 MG PO/OD

5) CAP BIO D 3 PO/OD 

6) INJ.ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE AFTER HD

7) INJ.OROFER 100 MG + 100 ML NS IV WEEKLY ONCE 

8) SALT RESTRICTION <1.5 gm / DAY & WATER RESTRICTION < 1.5 lts / DAY 

9) BP MONITORING 4th HRLY