63/M with CKD on MHD

MEDICINE CASE DISCUSSION

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CASE SCENARIO: A 63 year old male came for dialysis

HISTORY OF PRESENT ILLNESS: Patient was apparently normal 3 months ago, then he had c/o dribbling of urine, swelling of arms and legs, facial puffiness, nausea, vomiting, constipation and abdominal discomfort for which he went to a hospital in khamman where investigations were done.

1/9/2021

RBS: 215 mg/dl

Blood urea: 109

serum creatinine: 5.3

Uric acid: 8.9

albumin: 3.2

CUE: sugar ++

He was advised admission but he denied and went to NIMS, Hyderabad on 4/9/2021.

He presented with fluid overload, uremic symptoms and MHD was initiated through right femoral access. On examination, fundus showed diabetic retinopathy and USG kidneys showed loss of cd, so patient was declared ESRD and access was changed to right IJV permcath on 13/9/2021. Patient was having scrotal swelling during admission so HRUS scrotum was done and scrotal support advised for the edema.

H/O ulcer over left foot in December 2019, diagnosed as diabetic foot. Amputation of first left big toe done.

In December 2020 H/O SOB grade II since 2 months which progressed to grade III since 5 days, diagnosed as ADHF. CAG was done.

Fistula done on 5/10/2021.

PAST HISTORY:

He is a known case of DM II since 16 years and on insulin.

HTN since 3 months and on medication.

CAD since 2019. In December 2020, admission in cardiology for ADHF, S/P CAG advised CABG, but was not done.

EXAMINATION:

Pt is c/c/c

BP: 140/90 mm Hg

PR: 81 bpm

RR: 21 cpm