46 year old female with PEDAL EDEMA AND CAME FOR DIALYSIS

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46 YEAR OLD FEMALE PATIENT WITH CKD ON MHD WITH HTN+ DM+

CASE DETAILS 
46 YEAR OLD FEMALE PATIENT CAME TO HOSPITAL FOR DIALYSIS C/O PEDAL EDEMA (LT >RT) AND CELLULITIS IN LT LOWER LIMB 
K/C/O CKD WITH DM SINCE 15 YEARS,  HTN SINCE 20 YEARS

HISTORY OF PRESENT ILLNESS 
PATIENT WAS APPARENTLY ASYMPTOMATIC 5 YEARS AGO THEN SHE UNDERWENT EYE CATARACT SURGERY FOR RIGHT EYE  WHICH WAS NOT SUCCESSFUL AND THE PATIENT WAS ON CONTINUOUS PAIN KILLERS SINCE THEN FOR 4 MONTHS
THEN SHE WENT FOR REGULAR MEDICAL CHECK UP 2 YEARS BACK AND FOUND OUT SERUM CREATININE TO BE 7.0.
10 MONTHS BACK DIAGNOSED AS KIDNEY INFECTIONS UNDERWENT MEDICAL TREATMENT AND DJ STENT HAS BEEN KEPT
On 18 JAN 2022 PATIENT HAD SEVERE SOB (EVEN AT REST ) AND WAS ADMITTED TO LOCAL HOSPITAL FOLLOWING WHICH HER SERUM CREATININE WAS FOUND TO BE 14.0, SO A FEMORAL LINE WAS PLACED FOR DIALYSIS. SHE UNDERWENT 4 SESSIONS OF DIALYSIS FOLLOWING WHICH THE VEIN GOT CLOTTED AND LEAD TO PROGRESSIVE SWELLING OF THE LEFT LOWER LIMB AND DISCOLORATION. THE LINE WAS THEN REMOVED AND SUBCLAVIAN LINE WAS PLACED, LATER SHE THEN UNDERWENT 10 SESSIONS OF DIALYSIS TILL DATE IN VARIOUS LOCAL HOSPITALS.
BILATERAL PEDAL EDEMA (LT >RT) GRADUALLY PROGRESSIVE PITTING TYPE 
H/O BURNING MICTURITION 
NO H/O SOB AND REDUCED URINE OUTPUT

PAST HISTORY:
H/O HTN SINCE 20 YEARS STARTED DURING HER FIRST PREGNANCY WHICH WAS NORMAL DELIVERY AND IS ON MEDICATION 
H/O DM SINCE 15 YEARS WHICH SHE FOUND OUT IN HER MEDICAL CHECK UP DONE WHEN SHE GOT HER MOUTH DEVIATED TOWARDS RIGHT AND GOT RESOLVED ON MEDICATION
NO H/O EPILEPSY, ASTHMA

PERSONAL HISTORY 
DIET - MIXED
APPETITE - NORMAL
SLEEP - ADEQUATE 
BOWEL AND BLADDER - REGULAR
NO ADDICTIONS 

GENERAL EXAMINATION 

VITALS 
TEMP - AFEBRILE 
B.P - 150/60 mm Hg
P.R - 88 bpm
R.R - 18 vpm
GRBS - 168 mg/dl

PHYSICAL EXAMINATION 
PALLOR  +
ICTERUS - 
CYANOSIS -
KOILONYCHIA - 
LYMPHADENOPATHY -
PEDAL EDEMA  + BILATERAL ( LT >RT )

SYSTEMIC EXAMINATION 
CVS - S1 +, S2 +
RS - BAE +
CNS - NAD
P/A - SOFT , NON TENDER

LOCAL EXAMINATION 
C/O PAINFUL SKIN LESIONS OVER LEFT LOWER LIMB SINCE 2 MONTHS
H/O CLOT -> EDEMA FORMATION POST DIALYSIS  ->   CELLULITIS
PATIENT ON REGULAR DRESSING 

INVESTIGATIONS


USG
ECG

2D ECHO


CHARTING

                UREA    S.CREA-    Hb    ALP    ALBU-  
                              TININE                            MIN       
10/3/22     93          6.8          8      790       2.1       
3/3/22       62           4.2        8.7    680      2.1       
2/3/22      117         6.82
  
28/2/22     83          5.1         8.8     784       2.1     
25/2/22     98          4.9        

22/2/22    118        5.8         7.1     407       2.4    

17/2/22      79         4.1         8        328       2.3   

SHE UNDERWENT 4 SESSIONS OF DIALYSIS 

18/1/22      112          14
   
29/4/21       91          7.6

27/4/21       99           8
3/12/20      138          7



18/2/22
• SERUM NT- PRO BNP -   30690 PG/ML
• SERUM FERRITIN        -  1185 NG/ML
• SERUM  TIBC               -   123 IU/ DL
• SERUM LDH                 -   580 IU/L

3/12/20
PROTEIN EXCRETION  - 2737 MG/DL
MICRO ALBUMINURIA  -   > 350 IU/MG

TREATMENT 

1. FLUID RESTRICTION < 1.5 L /day
2. SALT RESTRICTION  <2 g/day
3. TAB. SHELCAL 500 MG/ OD
4. TAB. NODOSIS 5000MG /BD
5. TAB. OROFER XT /OD
6. TAB. BIO D3 /OD
7. TAB. PANTOP 40 MG/ OD
8. TAB. LASIX 40 MG /BD
9. TAB. ERYTHROPOIETIN 4000 IU ONCE WEEKLY
10. INJ. IRON SUCROSE 100 MG IN 100 ML NS
11. INJ. HAI S/C ACC TO GRBS
12. INJ. METROGYL 100 ML/TID




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