15 year old boy suffering with CKD and SOB

 PRESENTING COMPLAINTS:

A 15 yr old boy, resident of Nalgonda, studying 9 th class came to the casualty 6 days ago with c/o SOB 

History of presenting illness:

Patient was apparently asymptomatic 2 months back then he developed fever which was sudden in onset,intermittent associated with chills and  subsided on taking medication, which was followed by vomiting (2-3 episodes every day) which occurs after having dinner, it is associated with food particles and not associated with blood He had these episodes for 10 to 15 days. 

They went to the local hospital in nalgonda and the patient was found to have 62 mg/dl urea level and creatinine level was 8.3mg/dl , so they referred him to Hyderabad hospital, where they had been told that he has CKD, in a day urea level had raised to 135mg/dl and creatinine level had increased to 10.7.

They have immediately started him on dialysis. 5 sessions of HD were done and he felt better. 

5 days ago he came to the hospital with c/O of shortness of breath and chest pain which was dragging type occurs only during episode of SOB. 

No C/O palpitations, syncope attack

No C/O decreased urine 

No C/O decreased urine output , pedal edema, facial Puffiness. 

After getting admitted to the hospital he underwent 3 sessions of hemodialysis on 12 th, 13 th and 14 th of November during which his creatinine and urea levels decreased, but his urea levels increased again on 15 th. 

After dialysis patient felt better. 

Past history:

Hypertensive since 1 month and is on Tab.AMLONG 5 mg 

History of 3 transfusions 1 month back 

Not a K/C/O DM ,Asthma ,epilepsy ,thyroid disorders 

Family History :

No H/O renal problems in their whole family.

His paternal grandfather is diabetic and hypertensive

Personal History:

Diet - mixed 

Appetite - normal 

Sleep - adequate 

Bowel movements : regular 

Bladder movements : regular 

No history of alcohol consumption or smoking history 

 

General Examination:

Patient is conscious, coherent , cooperative

Pallor -present 

Icterus -absent 

Clubbing-absent 

Cyanosis -absent 

Generalised Lymphadenopathy-absent 

Pedal Edema -absent 

O/E:

Vitals: 

On day 1

Temperature : 98.6°F

BP: 140/90 mm Hg in right upper arm in supine position

PR: 76 bpm

RR: 20 cycles per minute

Spo2: 88% on room air

          96% at 4 litres of O2

Vitals: 

Temperature : afebrile 

Pulse rate : 96 bpm

Respiratory rate : 24 cycles /min 

BP : 140/100 mm of Hg 

SpO2 : 86 % at Room air .

GRBS : 121 mg%

Systemic Examination: 

CVS: S1,S2 heard no murmurs

CNS: normal

RS :

Bilateral Air Entry - present 

Bilateral crepitations heard at IAA and ISA.              

No wheeze .

PA: 

Soft ,non tender 

Bowel sounds +

CNS:

NAD 

Investigations :

On day 1

HEMOGRAM : 

Hb - 8.7

TLC - 7800

N - 50

L - 40

M - 05

E - 05

B -00

Pcv - 25.1

RBC - 3.19

Plt - 1.2

MCV -78.7

MCH -27.3 

MCHC - 34.7 

Blood group : A positive 

CUE : 

Pale yellow 

Albumin - 3+

Sugar -Trace  

Pus cells- 6 to 8 

Epithelial cells -3to 4  

FBS - 78

RFT: 

Creatinine - 9.2 

Urea - 119

UA - 5.5 

Na - 141

K - 5.6

Cl - 101

LFT : 

TB - 0.79

Db - 0.19

AST - 17

ALT - 10

ALP - 201

TP - 5.8

ALB - 3.4

A/G - 1.36

15-11-2021

Hb-6. 3 gm/dl

Platelet count -1. 7 lakh/cu.mm

Lymphocytes-17%

Neutrophiles-78%

urea-107

Creatinine-1. 6

Uric acids-2. 1

Calcium-7. 5

Phosphorus-8. 0

Sodium-148

Potassium-2. 9.

USG finding : 

Bilateral grade 1 rpd changes

Treatment:

T. NICARDIA - 10 mg  , TID

T. LASIX- 40mg   TID

T. Metal 50mg OD

T. CILINEDEFIONE  10mg  OD

T. TELMA 20mg BD 

T. LIVOGIN BD

Syp- GRILLNKTUS 15ml TID

NEB- BUDECORT 12th hourly

NEB-IPRAVENT 8th hourly

 Fluid restriction 

Salt restriction

MANITOR UTULS 2nd hourly