A 58year Old Male Patient With CKD On MHD

THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 
CHEIF COMPLAINTS:-
Patient came with c/o pedal edema since 10 days 
Not associated with shortness of breath 
HISTORY OF PRESENT ILLNESS:-
Patient was apparently asymptomatic 10 days back, then developed pedal edema (pitting type) upto ankle.
Not associated with shortness of breath or facial puffiness. 
Last Dialysis session-5/04/2022.
No H/O Palpitations,blurring of vision.
HISTORY OF PAST ILLNESS:-
No K/c/o Hypertension, Diabetes mellitus,
epilepsy, TB,cerebrovascular accident, coronary artery disease
PERSONAL HISTORY :-
Married 
Occupation-Farmer
Appetite-normal 
Diet- non vegetarian 
Bowels- regular 
Micturition- normal 
No known allergies 
Habits/Addictions-smoking since 7years
FAMILY HISTORY:-
No significant family history 
PHYSICAL EXAMINATION:-

•GENERAL EXAMINATION 
No pallor,cyanosis, lymphadenopathy, icterus, clubbing of fingers or toes.
No malnutrition, dehydration. 

VITALS 
Temp- 98.1°C/F
Pulse rate-88/ min
BP-140/90 mm/Hg
Spo2-98%

•SYSTEMIC EXAMINATION 
a)CVS- normal 
b) Respiratory system-BAE Positive 
c)Abdomen- soft,non tender ,
                      Liver,spleen - not palpable
                      Bowel sounds- yes
d)CNS- Patient is concious ,
           -   Speech is normal, 
           -    No signs of meningeal irritation like neck Stiffness, kerning's sign.
           -   Cranial nerves, motor system, sensory system are normal .
e) Cerebral signs 
     Finger- Nose in-coordination;knee-Heel in- coordination - yes
INVESTIGATIONS:-
PROVISIONAL DIAGNOSIS:-
CKD on MHD
TREATMENT :-
1. Inj- Erthropoietin-4000 IU/SC weekly 
2.Tab-Lasix-40mg PO/BD
3.Tab-Drofer
4.Tab-Pan-40 mg PO/OD
5.Tab-Nodosis-500mg PO/TID
6.Tab-Shelcal
7.Tab-BioD3-0.25 microgram PO/OD









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