A 50 year old Male with PKD

  Soumya Menda

3rd sem
This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent.
 Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.
This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.
I have been given this case 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 diagnosis and treatment plan.

case scenario : 

 A 53 old male came to casualty with complaints of 

loss of appetite and thrust since 2 months ,

decrease in urine output gradually since more than a month and also constipation, 

abdominal swelling and nausea since 15 days

bilateral pedal edema and shortness of breath since 10 days (grade 2)k/c/o HTN since 10 months and also diagnosed with CKD 15 years back.

History of illness:

* Patient was apparently asymptomatic 15 years back , suddenly developed urinary retention and constipation , shortness of breath, generalized edema and taken to hospital and underwent single Dialysis and then shifted to NIMS on the way there suddenly urinated and defecated then revealed edema and diagnosed with CKD with bilateral shrunken kidney with cysts 

*3 years back developed abdominal swelling (which developed gradually ) and pain ,altered sensorium taken to hospital and 3 litres ascitic fluid is aspirated ,and told about 70 % of liver damage due to alcohol consumption ,also had a single episode of seizure - treated with Epitan. 

Then he stopped alcohol and cigaratte smoking

*10 months back diagnosed with HTN when he had surgery to place rod due leg fracture when he fell down 

Personal history:

Married
lost appetite
mixed diet
Bowels - regular
Micturition - abnormal
No known allergies
Addictions - was alcoholic till past 3 years and used to smoking about 5-6 packs

Family history :

No significant family history 

General examination:

 Pallor present 
 No Icterus , cyanosis , clubbing of fingers , lymphadenopathy
 No Malnutrition
 Bilateral pedal edema
 Dehydration
 
Temp : 98.5 F
Pulse rate : 112 / min
RR : 18 /min
BP : 110/90 mm Hg
SpO2 : 99
GRBS : 115 mg%
 

CVS:

No Thrills
S1 , S2 heard
No cardiac murmurs 

Respiratory system : 

No Dyspnoea 
No wheeze
Position of trachea - Central
Breath sounds Vesicular

Abdomen : 

Shape of abdomen scaphoid
No tenderness
No palpable mass
Hernial orifices normal
No free fluid 
Liver and spleen are not palpable
Bowel sounds heard

CNS :

Conscious
Normal speech

Reflexes :                   Right            Left
        
      Biceps                     +2                +2
      Triceps                    +2                +2
      Supinator                +2                +2
      Knee                       +2                +2
      Ankle                      +2                +2

Cerebral signs :  Finger nose in coordination 

Provisional diagnosis :

   Chronic Kidney Disease - Polycystic Kidney Disease- Hyponatremia K/C/O HTN ( since 10 months )

Investigation : 

 





RFT :-

Serum Albumin :-

USG :-


Serology:-

Serology :-

Serology:-


CBP:-

CUE:-

ECG:-




Treatment:

on Day 1
1) Fluid restriction less than 1L / day
2) Salt restriction less than 2.4 gm/day
3) TAB. LASIX 40MG PO/TID
4) TAB. NICARDIA 20 MG PO/BD
5) TAB OROFER-XT PO/OD
6) TAB NODOSIS 550MG PO/BD
7) TAB SHECAL 500MG PO/OD
8) INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE
9) INJ IRON SUCROSE 1 AMP IN 100ML NS IV DURING DIALYSIS

On Day 2
  • Pt. C/C/C
  • Temp : Afibrile to touch
  • BP: 150/70 mmHg
  • PR : 81 bpm
  • CVS : S1, S2 present
  • RS: BAE present
  • P/A : Soft , NT

1) Fluid restriction less than 1L / day
2) Salt restriction less than 2.4 gm/day
3) TAB. LASIX 40MG PO/TID
4) TAB. NICARDIA 20 MG PO/BD
5) TAB OROFER-XT PO/OD
6) TAB NODOSIS 550MG PO/BD
7) TAB SHECAL 500MG PO/OD
8) INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE
9) INJ IRON SUCROSE 1 AMP IN 100ML NS IV DURING DIALYSIS

Day 3
  • Pt. C/C/C
  • Temp : Afibrile to touch
  • BP: 150/70 mmHg
  • PR : 82 bpm
  • CVS : S1, S2 present
  • RS: BAE present
  • P/A : Soft , NT
Urea :- 219 mg/dl
Creatinine : 17.5 mg/dl
Hb : 5.2 gm%
 
1 session of HD was performed on 18th along with transfusion of 1 unit of PRBC

1) Fluid restriction less than 1L / day
2) Salt restriction less than 2.4 gm/day
3) TAB. LASIX 40MG PO/TID
4) TAB. NICARDIA 20 MG PO/BD
5) TAB OROFER-XT PO/OD
6) TAB NODOSIS 550MG PO/BD
7) TAB SHECAL 500MG PO/OD
8) INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE
9) INJ IRON SUCROSE 1 AMP IN 100ML NS IV DURING DIALYSIS

Day 4 :


Urea :109 mg/dl
Creatinine : 11.3 mg/dl
Hb : 7.4 gm%


Day 5:

S :-
B/L Pedal edema present.
Decreased urine output.
Nausea present.

O :-
BP - 160/80 mmhg
PR - 81 bpm
Temp - afebrile
RR -16cpm
Spo2 - 99% at RA

CKD with Polycystic kidney disease with hyponatremia with known case of HTN since 10 months.

1) Fluid restriction less than 1L / day
2) Salt restriction less than 2.4 gm/day
3) TAB. LASIX 40MG PO/TID
4) TAB. NICARDIA 20 MG PO/BD
5) TAB OROFER-XT PO/OD
6) TAB NODOSIS 550MG PO/BD
7) TAB SHECAL 500MG PO/OD
8) INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE
9) INJ IRON SUCROSE 2 AMP IN 100ML NS IV DURING DIALYSIS
10) TAB ARKAMINE 0.1MG PO/OD
11) TAB ZOFER 4MG PO/TID

Urea : 115 mg/dl
Creatinine : 11.2 mg/dl
Hb : 6.8 gm%
1 session of HD was done along with transfusion of 1 unit of PRBC.
(2nd time dialysis)


Day 6:

B/L Pedal edema present.
Decreased urine output.

BP - 150/80 mmhg
PR - 83 bpm
Temp - afebrile
RR -17cpm
Spo2 - 99% at RA

CKD with Polycystic kidney disease with hyponatremia with known case of HTN since 10 months.


1) Fluid restriction less than 1L / day
2) Salt restriction less than 2.4 gm/day
3) TAB. LASIX 40MG PO/TID
4) TAB. NICARDIA 20 MG PO/BD
5) TAB OROFER-XT PO/OD
6) TAB NODOSIS 550MG PO/BD
7) TAB SHECAL 500MG PO/OD
8) INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE
9) INJ IRON SUCROSE 2 AMP IN 100ML NS IV DURING DIALYSIS
10) TAB ARKAMINE 0.1MG PO/OD
11) TAB ZOFER 4MG PO/TID
12)INJ. AVIL 1 amp IV Stat
13)INJ. HYDROCORT IV Stat
14)INJ. ZOFER 4mg IV/SOS


Urea : 42 mg/dl
Creatinine : 4.9 mg/dl
Hb : 8.4 gm%
1 session of HD was done




Day 7:

B/L Pedal edema present.
Decreased urine output.
Nausea present.

O/E
BP - 130/80/90 mmhg
PR - 82 bpm
Temp - afebrile
RR -16cpm
Spo2 - 99% at RA

CKD with Polycystic kidney disease with known case of HTN since 10 months.


1) Fluid restriction less than 1L / day
2) Salt restriction less than 2.4 gm/day
3) TAB. LASIX 40MG PO/TID
4) TAB. NICARDIA 20 MG PO/BD
5) TAB OROFER-XT PO/OD
6) TAB NODOSIS 550MG PO/BD
7) TAB SHECAL 500MG PO/OD
8) INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE
9) INJ IRON SUCROSE 2 AMP IN 100ML NS IV DURING DIALYSIS
10) TAB ARKAMINE 0.1MG PO/OD
11) TAB ZOFER 4MG PO/TID

Urea : 36 mg/dl
Creatinine : 2.9 mg/dl
Hb : 9.1 gm%
1 session of HD was done along with transfusion of 1 unit of PRBC.



Day 8:

 Hb :9.8%

B/L Pedal edema present.
Decreased urine output.

BP - 130/80 mmhg
PR - 81 bpm
Temp - afebrile
RR -17cpm
Spo2 - 99% at RA

CKD with Polycystic kidney disease with hyponatremia with known case of HTN since 10 months.


1) Fluid restriction less than 1L / day
2) Salt restriction less than 2.4 gm/day
3) TAB. LASIX 40MG PO/TID
4) TAB. NICARDIA 20 MG PO/BD
5) TAB OROFER-XT PO/OD
6) TAB NODOSIS 550MG PO/BD
7) TAB SHECAL 500MG PO/OD
8) INJ ERYTHROPOIETIN 4000IU S/C WEEKLY ONCE
9) INJ IRON SUCROSE 2 AMP IN 100ML NS IV DURING DIALYSIS

    Popular posts from this blog

    29 year old with bilateral lower limb pain

    Image
      I am Soumya 9th semester student . This is an e-LOG depicting patient's de-identified data centered approach for learning medicine. This log has been created after taking consent from patient and his family. Here we discuss about patient's problems with a series of inputs with an aim to solve them CASE SCENARIO 29 yr man from Miryalaguda ,a agriculture coordinator K/C/O CKD came to casualty with cheif complaints of Bilateral lower limb pain since 20 days HISTORY OF PRESENT ILLNESS Patient was apparently normal 3 years ago then developed pain in right lower abdomen diagnosed to have renal stones of size 4mm to 6mm and also raised creatinine upto 6 for which he had medication and both problem of stones and creatinine came down Then after 6 months he had bilateral ankle pain ,which is pricking type and precipitated by heavy work for which we visited a local doctor where he found rised uric acid levels , also adviced decrease protien rich diet along with medication  also had his...
    Read more

    OSCE questions

    Image
    https://soumyamenda80.blogspot.com/2023/11/29-year-old-with-bilateral-lower-limb.html 1.How NSAID abuse effects on kidney leading to renal injury and How long exposure and dosage can cause injury The main mechanism of NSAID action is cyclooxygenase (COX) enzyme inhibition, interfering on arachidonic acid conversion into E2 prostaglandins E2, prostacyclins and thromboxanes. Within the kidneys, prostaglandins act as vasodilators, increasing renal perfusion. This vasodilatation is a counter regulation of mechanisms, such as the renin-angiotensin-aldosterone system works and that of the sympathetic nervous system, culminating with compensation to ensure adequate flow to the organ. NSAIDs inhibit this mechanism and can lead to acute kidney injury (AKI). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534025/ 2.What other drugs or treatment modalities could be possible other than NSAIDs for pain? He had history of Rat poison ,does it have any significance in etiopathogenesis of the...
    Read more

    18 Y FEMALE WITH WEAKNESS IN LOWER LIMBS

    Image
    Soumya Menda 3rd sem This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent.  Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. I have been given this case 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 diagnosis and treatment plan. Case scenario: A 18 year old female came to causality on 8/7/21 with Cheif complaints of Weakness in both lowerlimbs.  Unable to stand and walk.   History of present illness: ...
    Read more