Gm case

75 YEAR OLD MALE WITH SOB

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Case:

A 75 year old male resident of  dorumpally came to casuality with swelling of both lowerlimb  and decreases urine output since 15days

HOPI:

Patient was apparently asymptomatic 20 week back then he took covid 19 vaccine and he was fine on that day. 

Next day he  got fever(which increased at night n subsidenin the morning) and could do his routine(Taking cattle to fields)which subsided on medication

Pt developed  bilateral pedal edema after fever got subsided  and he went to a private hospital in nalgonda and they suggested to undergo some investigation s and confirmed b/l renal failure 

Pt came to Kims casuality  ,10days back with complaints  of  bilateral pedal edema    insidious  in  onset,pitting type  gradually progressive to b/l knee associated with decreased urine output  and sob grade 2 to grade 3 not associated with orthopnea,PND, palpitations, giddiness, sweating

Pt also complaints of pain in the inguinal region when he coughs

Nocturia +

No froathy urine, burning micturition 

H/o fever on and off since 15 years, low grade, intermittent, not associated with cough, cold,headache, chills and rigors 

 Past history:

 He is a k/c/o hypertension since 7 months and is on regular medication

Not a k/c/o Diabetes,asthma, TB, CAD

He has no similar complaints in the past

Patient undergone cataract surgery 10years back

He underwent left  inguinalhernia surgery 20 years back

PERSONAL HISTORY

He has mixed diet,  appetite lost since 15 days,  adequate sleep, regular bowel and bladder movements 

He is occasional alcoholic , he used to smoke 8 years back

General examination:

Pt is conscious, coherent and cooperative

Moderately built and nourished

Pt is oriented to time,place,person

No pallor, 

NoIcterus,

Nocyanosis,

No clubbing, 

Nolymphadenopathy 

Edema: present 

     

              

Vitals :

Pt is c/c/c 

Temp- afebrile

Bp- 150/90mmHg

Pr-98 bpm

RR- 15cpm

Spo2- 100% on RA

CVS-S1,S2 +

RS-BAE+ NVBS

P/A- soft,non tender

         BS+

Rt Inguinal hernia present:

Rt Inguinal hernia swelling present since 1year

Swelling size :5*5cm

Visible impulse+

Cough impulse +

Reducible 

CNS- HMF intact

Provisional diagnosis: CRF with HTN

                     

Investigations:

Hemogram-

HB- 9.0

TLC- 5000

PLT- 80,000/cu.mm 

N- 79 

L- 15

E- 02

M- 04

B- 00

RBS- 182

CUE:

Albumin- +

Sugars- nil

Pus cells- 2-4

Epithelial cells- 2-3

RFT:

Blood urea- 152

Sr.Creat - 10.1

Sr. Electrolytes:

Na- 143

K- 4.7

Cl- 98

LFT:

TB- 1.10

DB- 0.30

SGOT- 11

SGPT- 10

ALP- 223

TP- 5.9

Serum Fe- 68

ECG:

USG

 Treatment:-

1) Fluid restriction < 1.4 L/day

2) Salt restriction <2.4 gm/day 

3) Tab.Lasix 40 mg PO/BD

4) Tab.Nicardia 10 mg Po/Tid

5) Tab.SHELCAL- CT PO/OD

6) CAP BIO -D3 PO/OD

7) TAB.NODOSIS 500 MG PO/OD