today the pt  came for follow up 
she looks  ill 
she was admitted   recently to the hospiital  
acute on top of chronic kidney injury    peacked  5 
potassium ok 


bp  190/94   hr  70  spo2  95% 
echo was done and showed mild pericardial effusion 


plan 
monocord 
cades
asa
calcium 
alfacal 
monocord 
pramin   pprn
rtc after  10 days 