This document summarizes the medical history and hospital course of a 51-year-old male patient named Attia Shawky who has been admitted for fever, rigors, and bone pain while undergoing dialysis through a temporary catheter. The patient has a history of end-stage renal disease and failed arteriovenous fistula. Initial workup showed infection with E. coli sensitive to amoxicillin-clavulanic acid. The patient was treated with antibiotics and a new dialysis catheter was placed, with plans for potential parathyroidectomy and bone biopsy.

1. Dr . Eslam Osama Ibrahim Sabri
Resident doctor of nephrology
NMGH

2. Personal history
51 years old male named Attia Shawky
from kafr El Badawi , married with 4
offsprings , driver.
No smoking , no special habit.

3. Past history
ESRD on RHD since 10 years
through Lt radio-cephalic AV fistula.
.No history of HTN
No history of DM.
No history of IHD.

4. Drug history
Calcimate 500 cap 2x3 within meals
One-alpha 1 tab 1x2
Pepzol 40 tab 1x1 before meals
Eprex 4000 unit sc once a week
Sacrofer vial once a week on dialysis session
Mimpara for one month ( stopped due to financial issue)

5. Family history
No family history of renal
diseases .

6. complain
Fever , rigors on dialysis session throurh rt
temporal catheterinserted 45 days ago,
boneache

7. Present history
Ptn admitted to our department on 17/7
complaining of fever , rigors on dialysis
session through rt temporal catheter
inserted 45 days ago.
Failed AV fistula ( thrombosed) since 50
days .
hyperparathyrodism since 4 months.ptn
received mimpara for one month then
stopped ttt due to financial issue.

8. GENERAL EXAMINATION
Ptn was fully conscious , alert , oriented ,
cooperative but looks very ill , depressed ,
short stature , curvature of back and pigeon
chest.

9. Vital signs
BP 110/80
HR 80/ min
RR 18/min
Temp 38.5

10. Local examination
Chest : bilateral fine basal crepitations , pigeon chest
Heart : normal s1 , s2 no murmur or added sounds .
Abdomen : normal contour of abdomen , no scars , no
.pigmentations , lax and soft
LL: bilateral mild pitting edema below knee with intact
.peripheral pulsations
.CNS : normal reflexes , powers and tones

11. Investigations
Blood chemistry and electrolytes
S.creat : 5.9 s.urea : 201
Na : 140 Ca : 11.1 po4 : 7.4 k : 5.4
CBC
TLC : 8.5 HGB : 11.5 PLT : 412
ABG
PH : 7.35 Pco2 : 35 Hco3 : 19.3
CRP 192 INR 1.37

12. -Bilateral mild pleural effusion .

13. x-ray femur and
pelvis
Fracture Rt femur
and Lt pelvis

14. Hospital course
.1- removal of Rt temporal catheter
.2-blood culture ( central , peripheral )
3- vancomycin 500 / 48 h
4-cefepime 1 gm / 24 h
5- Culture result is E.Coli and sensitive to amoxacillin and
clavulanic acid.
.6- Ptn is on augmetin 625 iv / 24 h .
.7- Insertion of Rt IJ catheter
8- RT AV Graft on 24/7

15. Lab sequence
21/720/719/718/717/7
10.7101111.511.4HGB
7.78.66.68.67.3TLC
8.487.15.95S.Creat
290245230201140Urea
139137136135139Na
5.65.45.35.44.2K
7.227.257.297.317.35PH
10.711.112.718.319.3HCO3
2527293835Pco2
3.33.33.43.93.7S.albumin
10.511.711.511.411.1Ca
7.18.28.18.37.4po4

16. We prepare patient for :
Permicath-
-
Parathyroidectomy
Bone biopsy-

17. THANK
YOU