DIMORPHIC ANAEMIA(BICYTOPENIA) WITH CKD(STAGE 4)

 Diagnosis

DIMORPHIC ANAEMIA(BICYTOPENIA) WITH CKD(STAGE 4) WITH 4 SESSIONS OF HEMODIALYSIS DONE (2019)


Case History and Clinical Findings

COMPLAINTS:

80 YEAR MALE WITH C/O TINGLING AND NUMBNESS OF BOTH UL AND LL SINCE 1 WEEK.


HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC TILL LAST WEEK,THEN DEVELOPED

HAEMATURIA SINCE LAST FRIDAY, IN EACH EPISODE OF URINE OUTPUT, WHICH LASTED

FOR 4 DAYS.NO AGGREVATING FACTORS, NO RELIEVING FACTORS.

H/O DECREASED URINE OUTPUT SINCE 1 MONTH, BUT INCREASED FREQUENCY.

NO H/O BURNING MICTURITION, HESITANCY OR URGENCY

NO H/O BLEEDING MANIFESTATIONS,PETECHIAE,RASH,NO HEMATURIA,NO BLOOD IN STOOL(MELENA),NO BLLEDING GUMS.

NO H/O FEVER, COUGH, COLD, PAIN ABDOMEN

NO H/O CHEST PAIN, PALPITATIONS, ORTHOPNEA AND PND ,TINGLING AND NUMBNESS OF UL AND LL SINCE 1 WEEK.

NO POLYPHAGIA,POLYDYPSIA,NOCTURIA

POLYURIA PRESENT


UROLOGY REFERRAL TAKEN IN VIEW OF HEMATURIA ?URINARY BLADDER CARCINOMA

DIAGNOSIS:BPH WITH GRADE 2 RPD CHANGES

ADVICE:T.TAMSULOSIN 0.4 MGX2 WEEKS

T.PANTOP 40MG X 1 WEEK

SYP.ALKASTON B6 15ML PO BD WITH WATER


PAST HISTORY:

N/K/C/O HTN,DM,THYROID DISORDERS,EPILEPSY

K/C/O RENAL CALCULI 2 YEARS BACK

H/O DIALYSIS 3 YEARS BACK(2 SESSIONS)


PERSONAL HISTORY:

DIET-MIXED

APPETITE-NORMAL

BOWEL AND BLADDER-REGULAR

ADDICTIONS-CHRONIC ALCOHOLIC SINCE 50 YEARS.90ML/DAY EVERYDAY TILL 2019.

NOW OCCASIONALLY ONCE A WEEK.

CHRONIC SMOKER SINCE 50 YEARS.5-6 BEEDIS PER DAY.


FAMILY HISTORY: INSIGNIFICANT


GENERAL EXAMINATION:

PATIENT IS CONSCIOUS COHERENT AND COOPERATIVE

NO PALLOR ,ICTERUS , CLUBBING,CYANOSIS,LYMPHADENOPATHY ,PEDAL EDEMA

SPO2 99% AT ROOM AIR

TEMPERATURE -98.2F

SYSTEMIC EXAMINATION:

CVS: S1,S2 HEARD ,NO MURMURS,JVP NOT RAISED

RS: BAE,NO ADDED SOUNDS ,NVBS

P/A: SOFT, NON TENDER,BOWEL SOUNDS CAN BE HEARD

COURSE IN THE HOSPITAL:

PATIENT WAS ADMITTED IN VIEW OF TINGLING AND NUMBNESS OF BOTH UL AND LL SINCE

1 WEEK AND COMPLAINED ABOUT HEMATURIA 1 WEEK BACK AND ON FURTHER


INVESTIGATIONS:

HB:7.4--6.9--7.8

TLC:4500--3900--5200

PLT:60,000--70,000--60,000

CUE:PUS CELLS:6-8

RBC:1-2

EPITHELIAL CELLS:1-2

BACTERIA:PRESENT

PATIENT HAD NO BLEEDING MANIFESTATIONS,PETECHIAE,RASH,NO HEMATURIA,NO BLOOD IN STOOL(MELENA),NO BLLEDING GUMS.


UROLOGY REFERRAL TAKEN ON 20/05/23 IN VIEW OF HEMATURIA ?URINARY BLADDER CARCINOMA

DIAGNOSIS:BPH WITH GRADE 2 RPD CHANGES

ADVICE:T.TAMSULOSIN 0.4 MGX2 WEEKS

T.PANTOP 40MG X 1 WEEK

SYP.ALKASTON B6 15ML PO BD WITH WATER


PATIENT WAS TREATED CONSERVATIVELY AND DISCHARGED IN STABLE CONDITION.


Investigation:

HB:7.4--6.9--7.8

TLC:4500--3900--5200

PLT:60,000--70,000--60,000


CUE:

PUS CELLS:6-8

RBC:1-2

EPITHELIAL CELLS:1-2

BACTERIA:PRESENT

RBS:101

LDH:208

RETICULOCYTE COUNT:1.1

SERUM IRON:5

UPCR:SPOT URINE PROTEIN:20.4

SPOT URINE CREATININE:60

RATIO:0.34

24HR URINE PROTEIN:278

24 URINE CREATININE:0.54

RATIO:0.51

2D ECHO:

-MILD AR,TRIVIAL TR/MR

-NO RWMA .NO AS/MS,SCLEROTIC AV

-GOOD LV SYSTOLIC FUNCTION

-DIASTOLIC DYSFUNCTION ,NO PAH/PE


USG ABDOMEN:

B/L GRADE 2 RPD CHANGES

B/L RENAL CORTICAL CYSTS


Treatment Given(Enter only Generic Name)

1.IVF AT 75ML/HR

2.TAB.DOLO 650MG PO SOS

3.INJ.THIAMINE 200MG IV BD IN 100ML NS

4.T.FOLIC ACID 5MG PO OD

5.T.LASIX 20MG PO BD

6.INJ.VITCOFOL 1000MCG IM/OD

7.TAB.NODOSIS 500MG PO OD

8.T.SHELCAL 500MG PO OD

9.T.OROFER XT PO OD

10.T.TAMSULOSIN 0.4 MG

11.T.PANTOP 40MG

12.SYP.ALKASTON B6 15ML PO BD WITH WATER


Advice at Discharge

T.FOLIC ACID 5MG PO OD

T.LASIX 20MG PO BD

INJ.VITCOFOL 1500MCG REGIMEN OD X 1WEEK,

ALTERNATE DAYX 1 WEEK,

WEEKLY ONCEX 1 WEEK,

MONTHLY ONCEX 3MONTHS.

T.SHELCAL 500MG PO OD

T.OROFER XT PO OD

T.TAMSULOSIN 0.4 MGX2 WEEKS

T.PANTOP 40MGX1 WEEK

SYP.ALKASTON B6 15ML PO/TID


Follow up:limitation in physical activity and morbidity

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