CASE PRESENTATION

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A 38 yr old female patient  presented to OPD with cheif complaint of shortness of breath since one month. 

HISTORY OF PRESENT ILLNESS : 

patient was asymptomatic 1 month back when she developed difficulty in breathing during mid sleep . 

Patient used to wake up at 6am  in the morning  and complete her brushing and she used to have tiffin and later she used to sit in the shop infornt of house . 

 She was taken to the hospital that night when she developed SOB . doctor digonsed it as a gastric problem and prescribed medication for 2 days .symptoms are slightly supresed .

Later she developed irregular menstruation 3/15 and consulted a gynocologyst . 

Scanning is done and doctor diagnosed it as anemia and asked to consult a higher hospital . 

Later dialysis was started 

PAST HISTORY : 

No history of DM , HTN ,TB 

Patient had irregular menstrual  cycle 2 yrs  back she used homeopathy medication for 5 months and recoverd 

No history of any surgeries .

PERSONAL HISTORY : 

Diet : mixed 

Apatite : low 

Sleep : adequate 

 Bowel and bladder: regular 

Addictions : no addictions.

FAMILY HISTORY : 

no relavant family history  .

GENERAL EXAMINATION : 

patient was concious coherent and cooperative .

Pallor is present 

No cynosis

No icterus 

No clubbing 

Vitals : 

Temperature: afibrile 

BP : 130/70 mm hg 

Respiratory rate: 18 cycles /min

Pulse : 80 beats per min 

SYSTEMIC EXAMINATION : 

CNS : consicious,  normal speech 

CVS : s1 and s2 are heard 

Respiratory: no wheezing sounds ,postion of trachea is central 

Per abdomen : no palpable mass , no fluid  , liver and spleen are not palpable .

INVESTIGATIONS: 

Blood urea :

serum creatinine :

Serum electrolytes: 

Hemoglobin : 

Random blood sugar : 

HBs Ag Rapid

HIV Rapid 

Anti HCV antibodies rapid 

DIAGNOSIS : 

Chronic kidney failure on MHD 

Treatment : 

Fluid Restriction <2L per day

Salt restriction < 2g per day

Tab.lasix 40 mg BD 

Tab .nicardia 10 mg BD 

Tab .orofex XT  OD 

Tab .shelcal XT OD 

vitals charting 6 hourly .