35/M CKD on MHD

A 35 year old male came to OPD with a chief complaints of

 Decreased appetite since 15 days
Vomiting since 15 days
Bilateral pedal edema since 15days
Shortness of breath since 5days 

HOPI
patient was apparently asymptomatic 1 and half year ago then he had symptoms of decreased appetite went to hospital then they diagnosed as kidney disease and he used medication for 1 month and stopped later after six months he developed shortness of breath and bilateral pedal edema then he opted for dialysis then after 1year came with symptoms of decreased appetite with vomiting from past 15days 2 episode per day which is insidious in onset non bilious ,non projectile contain food particles
He had H/O bilateral pedal edema which is pitting type from past 15days
H/o shortness of breath progressed to grade 2
PAST HISTORY:
K/C/O HTN SINCE 1YR ON TAB.CLINIDIPINE
H/O kidney disease i.e CKD since 2yr  on dialysis since

PERSONAL HISTORY 
Diet - mixed
Appetite decreased since 1month
Bowel and bladder -regular
Sleep -regular
Addiction - occasionally alcoholic stopped 1year back

FAMILY HISTORY
Not significant

TREATMENT HISTORY 
On antihypertensive since 1 year

GENERAL EXAMINATION 
Patient is conscious, coherent, Cooperative
No H/o pallor,icterus, cyanosis, lymphadenopathy 
H/o Edema of feet

Vitals 
Temperature 99.2F
BP 170/100 mm Hg
PR 97bpm
RR 20cpm
SPO2 99%
GRBS 115

SYSTEMIC EXAMINATION 
CVS S1 S2 heard ,no murmur 
RS- BAE present
CNS- NFND 
P/A soft ,non tender

INVESTIGATIONS:

SEROLOGY 






USG 

CHEST X-RAY 

ECG
Normal Sinus Rhythm 


PROVISIONAL DIAGNOSIS 
CKD ON MHD

TREATMENT
Day 1
TAB LASIX 40 MG PO BD 
TAB NICARDIA 10 MG PO TID 
TAB NODOSIS 500 MG PO BD 

Day 2
TAB LASIX 40 MG PO BD 
TAB NICARDIA 10 MG PO TID 
TAB NODOSIS 500 MG PO BD

ADVICE AT DISCHARGE
Patient advised for MHD thrice a week

FOLLOW UP 
REVIEW SOS

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