26 m btech with complaints of vomitings

 26/M btech,completed 3yrs back non alcoholic and a non smoker , developed vomitings 4-5episodes on23rd December: yellow colored,non bilious,non blood stained contained foodparticles/water. Thenafter patient used to have vomitings every day 2-3episodes or at times multiple episodes for  one &half month i.e till feb 11th

   After 15days of onset of vomitings i.e in January patient went to Suryapet hospital and there for the first time he was said to have high bp-170mmhg and brain imaging was done .Used anti hypertensive drugs for 10days and stopped
On February 12th he presented with :
1-multiple episodes of vomitings a day before,2-he noticed decreased urine output since January
 3- intermittent shortness of breath on walking for long distance
4-spasm of both calves since 5-6yrs monthly twice/thrice only night times due to which he used to get up from his sleep
His creatinine was 15mg/dl
On February 13th he was referred to NIMS
 i/v/o renal biopsy.There his shortness of breath was increased from grade2 to grade4 NYHA and immediately started hemodialysis.6-7HD done at NIMS and then he came back to our hospital.They denied renal biopsy due to high risk of bleeding.since then he is on HD weekly twice and continuing anti hypertensive drugs(nicardia 20mgBD). since one month he is noticing pedal edema in between dialysis and also shortness of breath 2days after each dialysis associated with orthopnea PND and insomnia 
On  Thursday (30-07-2020) he came for his regular dialysis but he complained of shortness of breath even at rest, abdominal tightness and pedal edema for with he was admitted in AMC.

General examination:

examination:






            

INVESTIGATIONS:








On 08-09-2020
He again came for dialysis,
INVESTIGATIONS DONE:
Came with complaints of sob so was admitted for evaluation.








26/12/2020














DIAGNOSIS:
CKD ON MHD WITH HTN WITH B/L TRANSUDATIVE PLUERAL EFFUSION SECONDARY TO HD

Treatment:

Salt and water restriction
Inj.augmentin 625mg od
Tab nicardia10mg tid
Tab.pantop 40mg od
Tab.lasix 40mg bd
Tab.orofer xt od
Tab shelcal.hs od
Tab nodosis 550mg od
Tab zofer 4mg tid
Nebulisation with budecort and salbutomol 8th hrly
Bp/pr/temp/spo2 and I/O charting monitoring



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