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What do my lab test results indicate?

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Posted on Mon, 9 May 2016
Question: Dear Sir,

I want to know whether my father is receiving the correct treatment.reports attached.
my father is k/c/o Dm with diabetic nephropathy, Hypertension and on below medication
Tab. Sevcar 400 mg TDS
Tab. CTD 6.25 OD
Tab. Ecosprin AV 1OD
Inj Ryzodeg 20Units before breakfast
Tab Galvus 50mg 1 after dinner


IRON 34
% TRANSFERRIN SATURATION 11.6

BLOOD UREA NITROGEN (BUN) 32.97
CREATININE - SERUM 2.25
URIC ACID 8.19
CALCIUM 8.53
BUN / SR.CREATININE RATIO CALCULATED 14.65

TOTAL CHOLESTEROL 107
HDL CHOLESTEROL - DIRECT 19
LDL CHOLESTEROL - DIRECT 49
TRIGLYCERIDES 278
TC/ HDL CHOLESTEROL RATIO CALCULATED 5.7
LDL / HDL RATIO CALCULATED 2.6
VLDL CHOLESTEROL CALCULATED 55.54
NON-HDL CHOLESTEROL CALCULATED 88.22

ALKALINE PHOSPHATASE 145
BILIRUBIN - TOTAL 0.3
SERUM GLOBULIN 3.59

HbA1c 10.3

3.92 TOTAL RBC
10.7 HEMOGLOBIN
36.1 HEMATOCRIT(PCV)
92.1 MEAN CORPUSCULAR VOLUME(MCV)
27.3 MEAN CORPUSCULAR HEMOGLOBIN(MCH)
29.6 MEAN CORP.HEMO.CONC(MCHC)
54.4 RED CELL DISTRIBUTION WIDTH - SD(RDW-SD)
16.4 RED CELL DISTRIBUTION WIDTH (RDW-CV)
16.3 PLATELET DISTRIBUTION WIDTH(PDW)
11.6 MEAN PLATELET VOLUME(MPV)
150 PLATELET COUNT
41 PLATELET TO LARGE CELL RATIO(PLCR)
0.16 PLATELETCRIT(PCT)
doctor
Answered by Dr. Abhay A Mali (1 hour later)
Brief Answer:
Treatment need to be modified.

Detailed Answer:
Hi,

Thanks for your question.
Noted your concern.

After going through your father's reports following parameters need to be taken care of-

1) Serum creatinine of 2.25:
Which denote CKD stage 3 or 4.
In such case I may have avoided use of Tab Galvus, instead I may suggest Linagliptin 5mg once a day which is of the same class as Galvus but more safe for kidneys.
close monitoring of weight is important along with this watch for swelling over legs or lower back, breathing difficulty if any.

2) Serum Uric acid 8.19.
For it use of Tablet containing Allopurinol or Febuxostat may be suggested.
Also avoid nonvegeterian food (proteins).

3) Serum Phosporus 5.2:
Continue use of sevelamer as before.

4) Iron deficiency:
Which need to be corrected.
I may have preferred Injectable iron preparation like iron carboxymaltose.
Oral iron supplement may cause gastritis, nausea possibility of which may be more in patient with CKD.

5) Blood sugar control:
HbA1c of 10.3 is quite high.
it need to be corrected with appropriate medicines preferably insulin (as safe for kidneys).
Instead of Galvus, Linagliptin may be suggested.
Along with this diet control and exercise as tolerated is important.

6) Continue using Ecosprin AV.
It is a combination of blood thinner and lipid lowering medicines.
Diabetes, blood pressure, dyslipidemia, CKD all are high risk for developing blood vessel complications (macro-vascular complications) use of Ecosprin AV may help in prevention.

7) Blood pressure treatment:
Tab CTD (Chlorthalidone) may cause hyponatremia (low Sodium level) which may have serious consequences hence Serum electrolytes need to be monitored at least once in a month.
Also use of ACE (Angiotensin Converting Enzyme) inhibitors or ARBs (Angiotensin Receptor Blockers) may be suggested as they help in prevention of progression CKD. But close monitoring of serum electrolytes (Potassium) is important with their use in the presence of deranged kidney function.

You should discuss all this with your father's treating diabetologist and nephrologist.

Hope this helps.

Regards,
Dr. Abhay Mali.
Diabetologist.




Above answer was peer-reviewed by : Dr. Deepak
doctor
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Follow up: Dr. Abhay A Mali (7 hours later)
Sir,

i visited the Diabetologist and Nephrologist and his final prescription is as below, please advise. Also suggest some generic substitutes

Nephrogoist Suggested below

T. Rantac 300 OD
T. Sevcar 400 1 TDS
C. Rocaltrol0.25 1 OD (please suggest some generic substitutes)
Inj. Encicarb 500mg in 100ml NS iv once in a week with a break of 1 week for 2 weeks

Diabetologist suggested below

T. Galvus 50mg 1 after dinner
Inj Ryzodeg 20units before breakfast
T. Avas 10mg after dinner
T. Cilacar 10mg after dinner
T. Febutaz 40mg OD
doctor
Answered by Dr. Abhay A Mali (1 hour later)
Brief Answer:
Your father can follow the given prescriptions.

Detailed Answer:
Your father can follow the given prescriptions.

I am trying to mention actual content of each medicine so that you can chose alternate generic or cheaper preparation.

T. Rantac 300 contains Ranitidine 300mg.
T. Sevcar 400 contains Sevelamer.
C. Rocaltrol 0.25 contains Calcitriol (active Vitamin D)
Inj. Encicarb 500mg is a iron supplement.
T. Galvus 50mg contains Vildagliptin as I have already meantioned earlier I may have suggested Linagliptin 5mg once a day instead of Vildagliptin.
Inj Ryzodeg contains Insulin Degludec.
T. Avas 10mg contains Atorvastain 10mg. I may have continued Ecosprin AV instead of it.
T. Cilacar 10mg contains Cilnidipine 10mg
T. Febutaz 40mg contains Febuxostat.

Hope this helps you.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Abhay A Mali (14 hours later)
thanks Sir.
doctor
Answered by Dr. Abhay A Mali (3 hours later)
Brief Answer:
Well come.

Detailed Answer:
I will be happy to answer your future quesries.
You can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954
Above answer was peer-reviewed by : Dr. Deepak
doctor
Answered by
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Dr. Abhay A Mali

Diabetologist

Practicing since :2006

Answered : 806 Questions

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What do my lab test results indicate?

Brief Answer: Treatment need to be modified. Detailed Answer: Hi, Thanks for your question. Noted your concern. After going through your father's reports following parameters need to be taken care of- 1) Serum creatinine of 2.25: Which denote CKD stage 3 or 4. In such case I may have avoided use of Tab Galvus, instead I may suggest Linagliptin 5mg once a day which is of the same class as Galvus but more safe for kidneys. close monitoring of weight is important along with this watch for swelling over legs or lower back, breathing difficulty if any. 2) Serum Uric acid 8.19. For it use of Tablet containing Allopurinol or Febuxostat may be suggested. Also avoid nonvegeterian food (proteins). 3) Serum Phosporus 5.2: Continue use of sevelamer as before. 4) Iron deficiency: Which need to be corrected. I may have preferred Injectable iron preparation like iron carboxymaltose. Oral iron supplement may cause gastritis, nausea possibility of which may be more in patient with CKD. 5) Blood sugar control: HbA1c of 10.3 is quite high. it need to be corrected with appropriate medicines preferably insulin (as safe for kidneys). Instead of Galvus, Linagliptin may be suggested. Along with this diet control and exercise as tolerated is important. 6) Continue using Ecosprin AV. It is a combination of blood thinner and lipid lowering medicines. Diabetes, blood pressure, dyslipidemia, CKD all are high risk for developing blood vessel complications (macro-vascular complications) use of Ecosprin AV may help in prevention. 7) Blood pressure treatment: Tab CTD (Chlorthalidone) may cause hyponatremia (low Sodium level) which may have serious consequences hence Serum electrolytes need to be monitored at least once in a month. Also use of ACE (Angiotensin Converting Enzyme) inhibitors or ARBs (Angiotensin Receptor Blockers) may be suggested as they help in prevention of progression CKD. But close monitoring of serum electrolytes (Potassium) is important with their use in the presence of deranged kidney function. You should discuss all this with your father's treating diabetologist and nephrologist. Hope this helps. Regards, Dr. Abhay Mali. Diabetologist.