A 60 year old man resident of Nalgonda weaver  by occupation came with                           


CHIEF COMPLAINTS : 

 *PEDAL EDEMA from 6 months 

*Decreased urinary output since 1 month 

*Vomitings since 10 days 

*Sob and facial puffiness since 2 days                    

HOPI:

Patient was apparently asymptomatic 6 months back then his creatinine was 3 mg/dl and was diagnosed with chronic kidney disease. Since 1 month he is complaining of decreased urinary output 

C/o vomitings since 10 days,non projectile,food particles as content,non bilious,non blood tinged 

C/o SOB since 2 days grade 2 and relieved by taking rest 

C/o facial puffiness since 2 days 


PAST HISTORY:


Patient is known case of Chronic renal failure 

:6 months back. 

*K/c/o DM since 15 years and on Inj mixtard

20U-x-8U

*He is a known case of hypertension for which he is on Amlong 10 mg 

K/c/o TB - 2 years back 


FAMILY HISTORY:


No relevant family history .


 *PERSONAL HISTORY : 

 

DIET :mixed 

APPETITE:Normal 

SLEEP: Inadequate 

BOWEL AND BLADDER : Decreased urine output since 1 month and normal bowel movements 

ADDICTIONS: Drinks alcohol occasionally stopped since 5 months 


GENERAL EXAMINATION:


Patient is conscious, coherent and co operative and the patient is moderately built and moderately nourished

 Pallor: absent


Icterus:absent


Clubbing: absent


Cyanosis: absent


Lymphadenopathy: absent

*BILATERAL PITTING PEDAL EDEMA +


*VITALS :


*TEMPERATURE:98°F


*BP :150/70 mmHg 


*PULSE RATE :84 bpm


*RESPIRATORY RATE :22 breaths per min



 *SYSTEMATIC EXAMINATION:


*CVS :S1 and S2 heard and no murmors 


*RS : 

•Dsypnoea: -

•wheeze: -

•Trachea : centrally placed 

•chest is normal 

•Bilateral air entry present


*ABDOMEN : 


∆Shape of abdomen: distended 

∆Tenderness : No 

∆palpable mass : No 

∆Liver : Not palpable 

∆Spleen : Not palpable



*CNS : No focal neurological deficit.

Investigations:

USG 



ECG 






Provisional diagnosis: 

AKI ON CKD 

DYSELECTROLYTEMIA (HYPOKALEMIA AND HYPONATREMIA)

TREATMENT: 

1) FLUID RESTRICTION <1 L/DAY

2) SALT RESTRICTION<2 gm/ day

3)INJ ERYTHROPOIETIN 4000IU SC / ONCE WEEKLY

4)INJ HAI SC /TID

   INJ NPH SC /BD ACCORDING TO GRBS

5) TAB NODOSIS 500 MG PO/BD

6) TAB OROFER XT PO/OD

7) TAB SHELCAL CT PO/OD

8) TAB AMLODIPINE 10 MG PO/OD

9) INJ MONOCEF 1g IU /BD 

1-X-1.

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