70 year old patient on MAINTAINANCE HAEMODIALYSIS

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A 70 year old male patient is on maintainance haemodialysis since 9 months.

HOPI: patient was apparently asymtomatic 9 months back and then developed shortness of breath (on and off), pedal oedema (pitting type), sqeezing type of abdominal pain, headache and dizziness.Later diagnosed as chronic renal failure and underwent dialysis twice weekly for about 9months and since 2 weeks it's been done thrice weekly.

PAST HISTORY: k/c/o HTN since 4 months .

Not a K/C/O  of DM, thyroid disorders, TB

PERSONAL HISTORY:He follows a mixed diet. Appetite -Normal, Bladder movements-normal,

Bowel movements-constipation since few weeks. Sleep- decreased.consumes alcohol occasionally and stooped 1 year back.

FAMILY HISTORY: No significant family history.

DRUG HISTORY: No known drug allegies and patient uses Nicardia 10 mg.

General examination : patient is conscious ,coherrent, co operative and well oriented to his surroundings.he is poorly built and nourished.no pallor ,no cyanosis, no icterus, no lymphadenopathy. bilateral pedal edema is seen and is of pitting type 

Vitals:. Temperature: afebrile. Pulse rate: 99 beats / min. Respiratory rate: 22 cycles / min. Bp: 80/90. Spo2: 99 GRBS-141 Mg/dl.

Systemic examination: 

Cvs: bilaterally symmetric chest wall .no precordial bulge .no thrills and no murmurs.

S1& S2 heard.

Respiratory system: no dyspnoea, no wheeze

Position of trachea- central, no adventious sounds heard

CNS: patient is normal and concious .reflexs are normal.

Treatment

Fluid restriction (<1l/day)

Salt restriction (<2g/day)

T· LASIX 40 mg PO BD

T. Nicardia 10mg PO BD

T. NODOSIS 500 MG PO BD

T. OROFER-XT PO BD

Inj.ERYTHROMYCIN 4000IU /sc weekly once

Inj. IRON SUCROSE 100 MG IN 100 ML NS DURING DIALYSIS

Provisional diagnosis: chronic renal failure