A 72-year-old female with a history of congestive heart fail | Figure 1

A 72-year-old female with a history of congestive heart failure (CHF) and end-stage renal disease (ESRD) on dialysis presents with worsening shortness of breath. Her chest X ray shows central pulmonary vascular congestion. She underwent dialysis yesterday. On physical examination, she has jugular venous distension, bilateral crackles on lung auscultation, and mild peripheral edema. Her blood pressure is 140/90 mmHg, heart rate is 88 bpm, and she is afebrile. Laboratory results are significant for the following:

• BUN: 5 mg/dL
• Creatinine: 7.5 mg/dL
• Potassium: 5.8 mEq/L
• BNP: 1,200 pg/mL
• Sodium: 136 mEq/L
• Hemoglobin: 11 g/dL.
  Is there a condition or diagnosis when enough fluid has not been removed?

Mr X is complaining of numbness on her right hand since last week.
She is a dialysis patient
Serum ca is 7.4 mg/dl
Ica is 0.81,0.89 mmol/l respectively
On CaCo3 625 mg 2 +2+1
Patient verbalized that she is compliant with CaCo3.
On Normal dialysate
Here when patient has to take Caco3 to normalize ca level, either with meal or after meal
If with meal why?
If before or after meal why?
Thanks

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