58 year old male with CKD on MHD.
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Chief complaints:
58 year old male, labourer by occupation, came to the OPD with the chief complaints of Shortness of breath since 15 days, worsened 3 days back, facial puffiness since 1 week.
History of Presenting illness -
Patient was apparently asymptomatic 4 years ago
4 years ago - pt complained of giddiness, went to a local hospital and was diagnosed as Hypertensive, on regular medication since then T. Nicardia 10mg, T. Arkamine 0.1mg sos
2 years back Pt developed B/L pedal edema, progressed gradually to knees, diagnosed with renal failure and initiated dialysis weekly twice
Left upper limb swelling, gradually progressing to current size, since 4 months . Swelling in the left chest region, gradually progressing to current size, since 4 months.
Back pain since 2 months, subsided on medication (T. Ultracet)
Shortness of breath since 45days
Grade II-III progressed to Grade IV since 15 days along with orthopnea .
27 days back - developed Facial puffiness
No c/o palpitations, giddiness, cold, cough, burning micturition.
PAST HISTORY -
Known case of Hypertension since 4years on Tab nifedipine 10mg OD
Not K/C/O TB, Epilepsy, Asthma, CAD.
Personal history:
He is a daily wage labourer , he goes to work in the morning and come in the evening. He used to drink toddy daily 1lit/ day since adulthood. Occasionally alcohol
After he got symptomatized , he used to go to work very lately and decrease in efficiency.
After diagnosed with hypertension, he stopped drinking toddy.
Appetite- normal
Diet- mixed
Bowel movement- Regular
Alcoholic stopped 4 yrs ago
Non smoker.
On examination:
Pt is C/c/c
No Pallor,Icterus,Cyanosis,Lymphadenopathy
Edema of feet + .
Vitals:
Pr:94bpm
Bp:130/90
Spo2:97% at RA
Temp - Afebrile
Today’s vitals:
BP:130/90
Pulse rate:95bpm
Spo2 -99% on 10ltrs of O2.
Systemic examination:
CVS - S1,S2 +
RS - BAE +
CNS - NAD
P/A- Soft, non tender.Investigations
Serology - Negative
Provisional Diagnosis -CKD on MHD.
Treatment:
Fluid restriction (<1l/day)
Salt restriction (<2g/day)
T· LASIX 40 mg PO BD.
T. Nicardia 100mg PO BD
T. NODOSIS 500 MG PO BD
T. OROFER-XR PO OD
T. SHELCAL-CT PO OD.
Clinical images:
X rays:
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