20years old female with CRF presented with shorness of breath
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TREATMENT given:
CASE SCENARIO:
A 20 yr old female came to the ward with chief complaints of shortness of breathe
since yesterday evening and complaints of vomitings 3 episodes 3days back .
The patient was apparently asymptomatic 2months back then she developed Bilateral pedal edema which is of pitting type also associated with facial puffiness with these complaints she went to hospital and performed investigations . The creatinine level of 9.5mg was advised hemodialysis but the patient was not willing for it
HISTORY OF PAST ILLNESS:
not a k/c/o HTN ,DM , TB ,asthma,epilepsy, thyroid.
PERSONAL HISTORY:
Marital status-Single
Occupation: nil
Diet: Mixed , Non vegetarian
Appetite: Normal
Bowels: Regular
Known Allergies: No
FAMILY HISTORY:
HTN ,DM in father
HTN in mother
both of them expired.
GENERAL EXAMINATION
Patient is conscious and coherent
Moderate built and moderately nourished
Well oriented to time, place and person.
No pallor
No Icterus
No cyanosis
No clubbing
No lymphadenopathy
Oedema of feet -no
No malnutrition
No dehydration
VITALS:
Temperature-99F
Pulse rate- 156/min
Respiratory rate- 28/min
BP- 140/70mmHg
SPO2 - 91%
GRBS- mg%
PROVISIONAL DIAGNOSIS :
Chronic renal failure
day2
TREATMENT given:
Day1
T. IVABRADINE 5mg PO/STAT
T.NODOSIS 500mg PO/BD
T.SHELCAL 500mg PO/OD
T.OROFER xt PO/OD
Inj.ERYTHROPOIETIN 4000IU weakly twice.
Cap. BIO-D3 PO/WEEKLY ONCE
UPDATE ON DAY2
Chronic renal failure
With Chronic glomerulonephritis?
Alports syndrome?reflex nephorpathy?
SOB relieved
No fever spike
1 session of hemodialysis done.
Fluid and salt restriction
Inj ERYTHROPOIETIN 4000IU weakly twice
T.NODOSIS 500mg PO/BD
T.SHELCAL 500mg PO/OD
T.OROFER xt PO/OD
Cap. BIO-D3 PO/WEEKLY ONCE
Inj.LASIX 20mg IV/BD ( IF SBP is >110mmHg
I/O charting
PB monitoring 4th hrly
Day 3
Chronic renal failure
With Chronic glomerulonephritis?
Alports syndrome?reflex nephorpathy?
No fever spike
2 session of hemodialysis done
Fluid and salt restriction
Inj.CEFTRIAXONE 500mg IV/BD
Inj ERYTHROPOIETIN 4000IU weakly twice
T.NODOSIS 500mg PO/BD
T.SHELCAL 500mg PO/OD
T.OROFER xt PO/OD
Cap. BIO-D3 PO/WEEKLY ONCE
Inj.LASIX 20mg IV/BD ( IF SBP is >110mmHg
I/O charting
PB monitoring 4th hrly
Thrombophobe ointmemt L/Afor L-U/L
Inj.ZOFER 4mg IV/TID
Inj.PAN 40mg IV/OD
Day4
Chronic renal failure
With Chronic glomerulonephritis?
Alports syndrome?reflex nephorpathy?
No fever spike
1 episode of vomiting yesterday night
Fluid and salt restriction
Inj.CEFTRIAXONE 500mg IV/BD
Inj EPO 4000IU weakly twice
T.NODOSIS 500mg PO/BD
T.SHELCAL 500mg PO/OD
T.OROFER xt PO/OD
Cap. BIO-D3 PO/WEEKLY ONCE
Inj.LASIX 20mg IV/BD ( IF SBP is >110mmHg
Thrombophobe ointmemt L/Afor L-U/L
Inj.ZOFER 4mg IV/TID
Inj.PAN 40mg IV/OD
I/O charting
PB monitoring 4th hrly
Day5
3rd session of hemodialysis done
Fluid and salt restriction
Inj.CEFTRIAXONE 500mg IV/BD
Inj EPO 4000IU weakly twice
T.NODOSIS 500mg PO/BD
T.SHELCAL 500mg PO/OD
T.OROFER xt PO/OD
Cap. BIO-D3 PO/WEEKLY ONCE
Inj.LASIX 20mg IV/BD ( IF SBP is >110mmHg
Thrombophobe ointmemt L/Afor L-U/L
Inj.ZOFER 4mg IV/TID
Inj.PAN 40mg IV/OD
I/O charting
PB monitoring 4th hrly
Day6
Fluid and salt restriction
Inj.CEFTRIAXONE 500mg IV/BD
Inj EPO 4000IU weakly twice
T.NODOSIS 500mg PO/BD
T.SHELCAL 500mg PO/OD
T.OROFER xt PO/OD
Cap. BIO-D3 PO/WEEKLY ONCE
Inj.LASIX 20mg IV/BD ( IF SBP is >110mmHg
Thrombophobe ointmemt L/Afor L-U/L
Inj.ZOFER 4mg IV/TID
Inj.PAN 40mg IV/OD
I/O charting
PB monitoring 4th hrly
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