Roni Faslah, 36 y.

o, MW 22
cc : Vomite since 2 days ago Present Illness History : Vomite since 2 days ago, freq 5x/days, content what he eat, volume half of aqua. Fatigue since 1 weeks ago Oedem at face since 2 weeks ago Patient have known suffer chronic kidney disease and hospitalized at m.djamil but patient dont want to do hemodialisa. History of high blood pressure since 2 years ago. Mixturation (+) normal Defecation (+) normal

Physical Examination : GA : Moderate, Consc : CMC, BP : 150/90 HR : 88x/I, RR : 20x/I, T : 36,4 C Eyes : Icterus -/-, anemis +/+ Lung : Vesikuler, rh -/- wh -/Cor : Regular rhythm, ictus palpable at 2 fingers medial LMCS RIC V, M1>M2 Abdomen : Liver and spleen not palpable, bowel sound + normal

Lab : Hb : 7,4 gr/dl Leucocyte : 5.800/mm3 Ht : 22% Trombosit : 100.000 /mm3 Ureum : 399 mg/dl Creatinin : 42,9 mg/dl Natrium : 121 mmol/l Kalium : 4,6 mmol/l Cl : 85 mmol/l BGR : 129 mg/dl

WD/ CKD stg V ec nefrosclerosis hypertension Hiponatremic et hypochloremic ec vomite Th/ Rest/ Low protein 48 gr Low salt II IVFD NaCl 0,3% 12 h/kolf Lasix inj 1 x 1 amp Bicnat 3 x 500 mg Folic acid 1 x 5 mg Candesartan 1 x 8 mg Domperidone 3 x 10 mg Transfusion PRC 1 unit until hb 10 gr/dl post lasix