A 45year old male with CKD and ascites
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A 45year old male patient came to casualty with complaints of shortness of breath and abdominal distension
He was apparently asymptomatic 3months back.
On November 18th 2022 he suffered with SOB then he went to an outside hospital and was diagnosed with kidney disease and was kept on medication but it did not improve so started on hemodialysis on November 22.
15 sessions of hemodialysis has been done.
History of reduced urine output.
History of abdominal distension and tightness of abdomen.
History of Hypertension since 3months for which he is on medication
No history of pedal edema, facial puffiness.
No history of diabetes mellitus,asthma
Patient works in a cycle repair shop.
His daily routine includes waking up at 7am, have breakfast and goes to work and eats lunch around 1:30pm and return from work around 6pm, eats dinner and goes to sleep around 9pm.
No significant family history
He has loss of appetite, takes mixed diet, reduced urine output, bowel movements are regular and has adequate sleep.
General examination
Patient is conscious, coherent and cooperative and well oriented to time,place and person.
He is moderately built and nourished.
Vitals:
Temperature: afebrile
Pulse rate:82 bpm
Blood pressure:160/90
Respiratory rate: 24cycles/min
There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema
On systemic examination, abdomen is soft, non tender, distended showing shifting dullness present
On CVS examination S1 and S2 heart sounds are heard.
Respiratory examination shows bilateral air entry present and vesicular breath sounds heard.
There are no focal neurological deficits on CNSexamination.
Provisional diagnosis
CKD on MHD with ascites
Investigations
Serum electrolytes: Sodium levels are 146mEq/l,
Potassium (3.9mEq/l) and Chloride (99mEq/l) are normal
Liver function test: Serum bilirubin 1.11mg/dl
Alkaline phosphate 285IU/L
Total proteins 6gm/dl
Albumin 3.4gm/dl
Serum creatinine:8.8mg/dl
Hemoglobin: 8.8gm/dl
Ascitic tap
Treatment
Tab LASIX 40mg PO/BD
Tab NODOSIS 500mg PO/BD
Tab NICARDIA 10mg PO/BD
Tab SHELCAL PO/OD
Tab OROFERXT PO/OD
Inj ERYTHROPOIETIN 4000IU SC/weekly once
SUCRAL syrup
Inj IRON SUCROSE during dialysis
CROMAFFIN Syrup BD
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