CHRONIC KIDNEY DISEASE CASE

CASE SCENARIO 

A 90yr old female came to the Casuality with Chief complaints of Fever since 7 days

HISTORY OF PRESENTING ILLNESS:-
Patient was apparently asymptomatic 10 days back but then she had bilateral pedal edema pitting type with fever and chills  intermittent and no evening rise in temperature she also had decreased urine output and decreased appetite since 10 days she has vomiting 3episodes 5 days back  which was non bilious and non projectile containing food particles resolved after taking medication 

CHIEF COMPLAINTS - 
    Fever -10 days 
    Decreased appetite - 10 days  
    B/L pedal edema - 10 days 
     Decreased urine output -10 days   
    Vomiting- 5 days back 

 PAST HISTORY:-                                                             
  No C/O - chest pain
  H/O- Hypertension - 2yrs on medication
                                                
Not a K/c/o Asthma,Epilepsy,Tb

TREATMENT HISTORY:-
Tab.Amlodipine5mg
            +
Tab.Atenolol50mg
PERSONAL HISTORY


 Married

Occupation - farmer

decreased appetite

Bowel - regular

Micturition- decreased

 No ADDICTIONS-

No addictions

FAMILY HISTORY

Diabetes - No

Asthma - No

Hypertension - yes

Heart disease - No

Stroke - No

Cancer -No
 
INVESTIGATIONS :-
Hemogram,Renal function test,ECG,USG abdomen,chest x-ray.

Hb:6.1

PCV:19.2

TLC:9,400

RBC: 2.08

Platelet count:2.69

Blood urea: 2.14

Serum creatinine :10.0

S.Na+:126

S.K+:5.8

S.Cl-:89

PROVISIONAL DIAGNOSIS

Chronic renal failure 
Ultrasound :-



GENERAL EXAMINATIONS



 No-

Icterus/Cyanosis/Lymphadenopathy/Malnutrition



Temperature -98.4F

Pulse rate - 82beats /min

Bp - 140/90

SpO2 - 98%

GRBS - 160 mg%



SYSTEMIC EXAMINATION
CVS:  



No Thrills

Cardiac Sounds - S1, S2 +

No cardiac murmurs







RESPIRATORY SYSTEM: 



Dyspnoea - No

No Wheezing

Position of Trachea - central

Vesicular sounds 







ABDOMEN:



Shape - Scaphoid

No palpable mass

Bowel sounds- present





CNS:



Level of consciousness - conscious

Glassgow scale -E4 V5 M6





GAIT, MUSCULO SKELETAL SYSTEM, SKIN, ENT, HEAD AND NECK - NORMAL 

PUSTULAR LESIONS SEEN IN ORAL CAVITY

PRESENT ON HARD PALATE AND OROPHARYNX

TREATMENT :-

IV fluid 20 ns  IV/BOLUS

IVF  0.9% NS 100ml/hr 

Inj.pan 40 mg IV/STAT

Inj. LASIX mg IV/STAT

Inj zofer 4mg IV/STAT

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