I'm attached to the female general ward. I need to present this case in very detail as my preceptor is very strict and I need to have a very good understanding of the case and all the guidelines-based recommendations, like CPG Malaysia, and so on. The patient is still in the ward, and since I'm on holiday till 14/6, I'll go back to the ward on 15/6 and update the remaining info about the patient's medicine and disease progression, status. For now, this is the information I got about the patient. Usually the flow of presentation goes like: Flow of presentation: 1. Patient, age, gender 2. ⁠what is the chief complaint 3. ⁠what is the diagnosis 4. ⁠on day 1 admitted, wht problem then give what medication, indication for what, then is it appropriate to give the med for this problem, any more better option? (No pci then skip nxt day- same flow summary - until the last day) 5. ⁠next day, some symptoms resolve, dr stop certain medication due to …. Then some other problem arise and dr prescribe ….. the indication for the medication is for …… is it appropriate….. 6. ⁠overall no PCI in this case / u found some pci and need some clarification….. 7. ⁠thank you but rather than solely mentioning if the medications are appropriate or not, it would be better to state the indications. For eg, this pt was started on Tab pantoprazole 40mg BD for (indication) from (duration). Then if anything was found inappropriate/incorrect, it can be mentioned as a PCI & then explain accordingly. Your flow is correct. Just follow the CP2 sections. Ill attach the CP2 form. But some preceptor wants it to b like a story telling like : 1. Patient, age, gender 2. ⁠what is the chief complaint 3. ⁠tell the diagnosis , then the medicines instead of the medicine first then the indication. And carry on with the flow So i want u to generate 2 types of complete script for my presentation Name: Losila Age: 48 Race: Malay Underlying: DM with target organ damage (DKD and diabetic retinopathy), Hypertension, ESKD secondary to DKD (applying zakat for HD centre placement, awaiting approval plan for AVF appointment in June 2026, USCO KUB 6/1/25 CBK renal parenchymal disease Deny taking traditional medicine Was working as a cleaner for 5 years previously Blessed with 4 children Presented to ED on 9/6/2026 2.10 am Patient’s old medicines: Data taken 10/6/26 11 am Medication Dose Frequency Status T. Frusemide 40 mg 80 mg BD Increase to 80 mg TDS T. Metoprolol 100 mg 100 mg BD C T. Felodipine 10 mg 10 mg BD C T. Zincofer 1/1 OD C S/C Insugen R 12 IU TDS C PRN S/C Insugen N 28 IU ON WH T. Vildagliptin 50 mg 50 mg OD WH R. Rosuvastatin 20 mg 20 mg ON WH Section Investigation Normal Range 4/10/25 9/6/26 2 am 9/6/26 5 am 9/6/26 11.45 pm 11/6/26 FBC TWBC 4–11 ×10⁹/L — 10.9 — 8.66 8.74 FBC Hb 11.5–16.5 g/100 mL 9.5 8.8 — 6.8 6.6 FBC Platelet 150–400 ×10⁹/L — 193 — 179 187 Renal Profile Urea 1.7–8.3 mmol/L 13.3 33.1 33.5 21.4 22.5 Renal Profile Na⁺ 135–145 mmol/L — 136 138 141 142 Renal Profile K⁺ 3.5–5.0 mmol/L — 6.1 6.1 4.6 4.8 Renal Profile Cl⁻ 96–106 mmol/L — 113 116 110 110 Renal Profile SCr 64–122 µmol/L 399 1408 1415 1052 1127 Renal Profile CrCl 105–150 mL/min — — — — — Renal Profile Ca²⁺ 2.1–2.6 mmol/L — 1.86 — — — Renal Profile Mg²⁺ 0.7–1.3 mmol/L — 0.86 — — — Renal Profile PO₄³⁻ 0.8–1.45 mmol/L — 2.97 — — — LFT Albumin 35–50 g/L — 26 — — — LFT T. Bilirubin <20 µmol/L — — — — — LFT T. Protein 66–87 g/L — — — — — LFT ALP 53–141 U/L — — — — — LFT ALT <32 U/L — — — — — Coagulation PT 10–13.5 sec — — — — — Coagulation APTT 26–42 sec — — — — — Coagulation INR <1.5 — — — — — CE CK 24–195 U/L — — — — — CE LDH 0–248 U/L — — — — — CE AST <37 U/L — — — — — ABG pH 7.35–7.45 — 7.17 7.23 — — ABG pCO₂ 35–45 mmHg — 30 27 — — ABG pO₂ 72–100 mmHg — 246 196 — — ABG HCO₃ 22–29 mmol/L — 10.9 11.3 — — ABG O₂ sat 90–95% — 100% 100% — — Others RBS <11 mmol/L — — — — — Others Lactate 0.5–1.6 mmol/L — 1 1 — — Others Iron 13–27 µmol/L — 9.2 — — — Others Transferrin 2.0–3.6 g/L — 1.5 — — — Others Ferritin 15–205 ng/mL — 231 — — — Others TSAT (%) 15–50% — 21 — — — 9/6/2026 2.30 am Patient came to ED -SOB x 1/12 -Worsening past 2/7 -Requiring for sleeping in sitting position -With orthopnea and Paroxysmal Nocturnal Dyspnea (PND) -Prodcutive cough x 2/52 (yellowish sputum) -Claimed had fever x 2/52 ago -Seek treatment at Hospital Jitra, resolved after given 1 course of antibiotics -Vomiting and loose stool x 2/7 -Vomited fluid content, total 2x -Loose stool around 4x a day, no blood -Associated bilateral lower limb swelling -Non compliant to ROF 500 cc -Still has urine output Otherwise: - no chest pain, no abdominal pain, no sick contact, denied taking outside food recently Upon Arrival to ED, BP: 252/116 mmHg HR: 106 bpm T: 36.3 SPO2: 100% Lungs crepitation bilateral lung CVS: DRNM PA: Soft, non tender Pedal edema up to knee level bilaterally Started on mask CPAP at 2.10 am (9/6/2026) Medicines given in ED: IV lytic cocktail x 2 given at 1 pm 9/6/2026 IV lasix 80 mg STAT given 2.30 am 9/6/2026 and Iv lasix 80 mg TDS given 9.30 am 9/6/2026 IV pantoprazole 40 mg STAT and OD given 2.30 am 9/6/2026 IV GTN titrate accordingly IV Augmentin 1.2 g TDS given 9 am 9/6/2026 9/6/2026 7.30 pm Currently: -Under NPO2 -Done HD today, completed 2H with 10pc transfusion, UF 2C + blood product -On IV GTN -SOB improving -no GI losses -No nausea/vomiting O/E: alert, not tachypneic BP: 180/84 mmHg PR: 92 bpm T: 37 SPO2: 100% under NPO2 DXT: 6.5 Lungs: Bibasal crepts CVS: DRNM Pedal Edema up to the knee CXR: Congested, cardiomegaly Impression: Fluid overload secondary to hypertensive emergency/Advanced CKD Hypochromic macro/micro (I'm not sure) cytic anemia, likely renal anemia Plan: Continue NPO2 KIC off cm Keep SPO2 >95% Keep MAP > 65 Titrate IV GTN accordingly 5) Strict I/O charting ROF 500 cc/day DXT QID Medication: IV Lasix 800 mg TDS, S/C actrapid 6U PRN if DXT> 12, T. Zincofer 1/1 OD, T. CaCO3 500 mg BS Take old medication 9/6/2026 9.25 pm Have done HD 2H today Under NPO2 No fever O/E: Alert, concern BP: 216/110 HR: 105 bpm T: 37 SPO2: 98% Impression: Advanced CKD approaching ESRF with fluid overload, hyperkalemia, metabolic acidosis, and uremia Acute pulmonary edema (APO) secondary to Hypertension emergency Symptomatic anemia secondary to chronic disease and Iron deficiency anemia (IDA) Plan: Continue IV GTN Keep NPO2 IV Lasix 80 mg TDS Take blood Oral Kalimate 15 mg TDS x 3/7 given 9/6 starting 10pm KIV HD if indicated RRT: HD 10/6/2026 8am Diagnosis: Advanced CKD approaching ESRF with fluid overload, hyperkalemia, metabolic acidosis, with uremia Acute pulmonary edema (APO) secondary to Hypertension emergency Symptomatic anemia secondary to chronic disease and Iron deficiency anemia (IDA) *Completed HD yesterday 2H, UF 2.0L + blood product - uneventful Currently: Under NPO2 No fever SOB improving O/E:alert, conscious, not tachpneic BP: 145/83 mmHg PR: 79 T: 37 SPO2: 98% Under NPO2 DXT: 6.7 Lungs: Bibasal Crepitations Pedal edema B/L up to midshin I/O : 227/1600/-1273 Plan: Off IV GTN Trial wean down to RA Keep SPO2> 95% ROF 500 cc/day Strict I/O charting To indent CKD diet To insert IJC once plan for discharge Long term: RRT (To get application from zakat, continue AVF TCA July 2026) DXT QID IV Lasix 80 mg TDS given 6 am, then not given 12 pm, 6pm because oralised T. Zincofer 1/1 OD given 10/6 8 am T. CaCO3 500 mg BD given on 10/6 at 7 am and 5 am 10/6/2026 9.25 am Currently: Under NPO2 No fever SOB improving O/E:alert, not tacypneic, speak in full sentences BP: 169/81 mmHg PR: 79 T:37 SPO2: 100% under NPO2 DXT: 6.7 Lungs: minimal Right lower limb crepitations Pedal Edema B/L lower limbs Impression: Fluid overload secondary to non compliant to ROF with underlying CKD stage 5 U/L diabetic (control) Hypertension Plan: Oralize T. Lasix 80 mg TDS (first dose given 10/6 at 6 pm) ROF 500 cc/day Aim off GTN evening KIV prazosin if BP persistently high KIV HD cm Refer dietitian for reduced salt diet Oral Kalimate 15 mg TDS x 3/7 given 10/6 at 8 am, 4 pm, and 10 pm 10/6/2026 12.49 pm Currently, patient tolerate orally - minimum amount Estimated height: 158 cm Dosing weight: 56 kg EER: 1400-1680 kcal/day EPR:0.6-0.8 g/kg/day Hb: 6.8 Albumin: 26 K+: 6.1 reduced to 4.6 Plan: Educate patient on low sodium , low potassium and low phosphate diet Encourage orally as patient tolerated in ward Ward to indent: Low potassium diet 11/6/2026 8.30 am Diagnosis: Fluid overload secondary to non compliant to ROF with U/L CKD Stage 5 Currently: Under RA No fever Bilateral pedal edema Lungs: right lower zone event O/E: BP: 130/62 mmHg PR:70 bpm T:37 SPO2: 97% DXT: 5.9 I/O: 550/500/+ 50 Plan: To consult nephro for HD today To transfuse 10 pc? During HD Upcoming HD on Sunday To keep over weeword?? For IJC insertion on Sunday (unable to lie flat for IJC today) Off oral kalimate (one dose already guven at 8 am) Off Continuous bladder drainage (CBD) T. Zincofer 1/1 OD given 11/6 8 am T. CaCO3 500 mg BD given on 11/6 at 7 am only and stopped T. CaCO3 1 g TDS is planned but havent given so far T. Lasix 80 mg TDS given at 7 am, 1pm, 6 pm Continue patient own rosuvastatin 20 mg OD 11/6/2026 11.50 am Plan: For 4H HD today QB 250, QD 500 Heparin normal Transfuse 1Q packed cell during HD To insert IJC on Sunday 11/6/2026 12.50 pm Spoken to Dr Hana request 1Q packed cell to tranfuse during HD Not granted i/v/o blood group A+ low in stock To request back if Hb drop post HD