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Authors : Dr. Bharath Pgy1, Dr. Sai charan Pgy2.
The 55 year-old House wife presented to Nephrology with chief complaints of
shortness of breath since two days
Decreased urine output since two days
bilateral lower limbs since two days
Patient was apparently a symptomatic six years back then developed bilateral pedal edema pitting type for which she visited hospital and diagnosed with hypertension and renal failure, since then she was on regular anti hypertensives and conservative treatment for Renal failure.
Now since few days patient is having shortness of breath initially on exertion now progressed to even at rest which is not associated with chest pain , no palpitations, No nausea & vomitings. Associated with bilateral pedal edema pitting type upto knee and decreased urine output.
No burning micturation, no fever.
K/C/O HTN & CKD since 6 years.
Personal history :
Appetite : decreased
Diet : mixed
Sleep : adequate
Bladder : decreased urine output
Bowel movements: regular
Addictions :absent
General examination:
Pallor: present
Icterus: absent
Cyanosis : absent
Clubbing : absent
Lymphadenopathy : absent
Edema : present B/L pitting type of pedal edema.
Vitals:
Temperature: afebrile
Pulse: 106 bpm
Blood pressure:160/80 mm of hg
Respiratory rate : 32 bpm
SpO2 : 92 on RA
GRBS : 418 MG/DL
Systemic examination:
Cardiovascular system
JVP -raised
Visible pulsations: absent
Apical impulse : left 5th intercostal space in midclavicular line.
Thrills -absent
S1, S2 - heart sounds heard
Pericardial rub - absent
Respiratory system:
Patient examined in sitting position
Inspection:-
oral cavity- Normal ,nose- normal ,pharynx-normal
Shape of chest - normal
Chest movements : bilaterally symmetrically reduced
Trachea is central in position.
Palpation:-
All inspiratory findings are confirmed
Trachea central in position
Apical impulse in left 5th ICS,
Chest movements bilaterally symmetrical
AUSCULTATION
B/L diffuse crepts present.
Abdomen examination:
INSPECTION
Shape : distended
Umbilicus:normal
Movements :normal
Visible pulsations :absent
Skin or surface of the abdomen : normal
PERCUSSION- tympanic
AUSCULTATION :bowel sounds heard
Labs :
Diagnosis:
CKD 2to
?Diabetic nephropathy with DM & HTN
Treatment :
1. Hemodialysis initiated on 11/6/22
2. Inj. PIPTAZ 2.25gm IV TID
3. T. Lasix 4o mg BD
4. Inj. HAL S/C TID acc to GRBS
5. T NODOSIS 500mg BD
6. T. Orofer-XT OD
7. T. Shelcal 500mg PO OD
8. T. Amlong 10mg BD
9. T. Met-XL 25 mg OD
4 sessions of hemodialysis done on 10,11,14,16 of June 2022.
XRAY at the time of discharge:
In due course of treatment patient developed involuntary movements of face, neck ( myoclonic jerks 2to Uremia ) T. Sodium valproate 200mg BD added.
Discharged on 18/6/22.
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