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46 year old man with CKD on MHD

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 A 46 year old man who was a sand blaster came to the hospital with complaints of loss of appetite since 3 months. Three months ago, he suddenly felt a decrease in his appetite and only ate one roti three times a day. Then one month ago, he had an episode of vomiting after eating mutton. It was food in content and non-bilious. Then, he went to his local hospital which told him he has a kidney problem and that he needs dialysis. Therefore, he underwent dialysis there then came to our hospital for dialysis due to financial problems. At our hospital, he was diagnosed with hypertension.  General examination: The patient was conscious, coherent, and cooperative, oriented to time, place, and person. No history of pallor, icterus, cyanosis, clubbing, lymphadenopathy, and edema No H/O nausea, fatigue, dehydration, constipation, decreased urine output, hematuria Day 1 O/E: BP: 150/90 mmHg PR: 92 bpm  CVS: S1S2 heard, no murmurs  RS: BAE present P/A: soft, non-tender Rx: 1) Inj. Levipil 500 mg/I