A 45 yr old male with swelling on both legs and difficulty in breathing
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K.Lahari
Roll no. 61
A 45 yr old male welder by occupation resident of suryapet came to opd with chief complaints of swelling in leg since 2 months and difficulty in breathing since 10 days.
HOPI-
Patient was apparently asymptomatic 3yrs ago. Then he developed swelling in both legs till mid thigh and facial puffiness for which he visited our hospital . He stayed here for 6 days and was on medication and his swelling was subsided.
He went back home.
But 10 days later he had again swelling on both legs till hip joint so he was taken to a hospital in the city there after a series of test he was found to be having kidney failure. He was given 12 dialysis for alternate days and was sent back home to continue dialysis in his native place.
He went to 'A' hospital in his native place where his creatinine levels were found to be low and he was told to not have dialysis and sent back home.
He was at home retired with intermittent swelling on both legs for 2.5 yrs with the line used for dialysis still attached to his chest (which was kept when he was in city hospital) and he had intermittent swelling on legs.
But his line was detached and also as he had swelling on both legs he went to govt hospital in his hometown where because of low creatine levels he was sent back. So patient went to private hospital in his home town where they reattached line for dialysis on his hand and started him on dialysis like 1-2 months ago. He was given 10 dialysis on alternate days but there was no reduced swelling on leg and he started having difficulty in breathing and hypertension so he was referred to our hospital.
On his was here after having his breakfast he was having difficulty in breathing(grade 4)and was taken to emergency care in our hospital.
COURSE DURING STAY IN HOSPITAL-
He was brought to our hospital on 27/08 and the same night he was given:-
1st dialysis in our hospital 27/08 night
2nd dialysis 29/08 morning
3rd dialysis 30/08
4 th dialysis 01/08 morning
He is having hypertension and difficulty in breathing,(grade 4) but his swelling on leg reduced.
No history of any fever or burning micturation.
Known diabetic for 8 yrs and is on medication.
Known hypertension for 3 yrs and on medication.
He is a ckd patient since 3 yrs
PAST HISTORY-
Known tuberculosis 10 yrs ago and was on medication.
Not a known case of asthma, leprosy, cad. .
PERSONAL HISTORY-
Diet - mixed
Appetite - normal
B&b - normal
Addictions - Alcohol since 22 yrs every alternate day.
He has toddy, whisky and all other variants full glass
He stopped alcohol since his 1st visit to hospital for bilateral pedal edema 3 yrs back.
Allergies - none
FAMILY HISTORY-
No known family history.
GENERAL EXAMINATION-
Patient is conscious coherent and co operative well oriented to time place and person.
Patient was examined in a well lit room and consent was taken.
Vitals -
PR-78 bpm
BP- 150/70
RR-16cpm
SPo2-
Temp-Afebrile
Pallor - Absent
Icterus - absent
Clubbing - Absent
Cyanosis- Absent
Lymphadenooathy- absent
Edema - present b/l pedal pitting type
SYSTEMIC EXAMINATION-
CVS-
S1, S2 heard.
RESP-
Dyspnea present
Trachea central
ABD-
Soft obese and non tender
INVESTIGATIONS-
HAEMOGRAM-
RFT-
LFT-
CUE-
2D DOPPLER-
ECG-
27/08-
28/08-
PROVISIONAL DIAGNOSIS-
CKD ON MHD
PLAN OF CARE-
Fluid and salt restriction
Inj. Lasix - 40mg i/v
Inj pantop
Tab nicardia 20 mg
Tab isosorbide dinitrate
Tab carvidilol
Tab shelcal - 500 mg B/d
Tab orofer-xt
On 30/8/2022
Fluid and salt restriction
Inj. Lasix
Inj pantop
Tab nicardia
Tab isosorbide dinitrate
Tab Nodosis
Tab orofer xt
Nebulizer with budicort- 12 th hrly
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