60 year old male with pedal oedema and loss of appetite
GENERAL MEDICINE CASE -
A 60 year old male farmer by occupation resident of nalgonda came to casualty with chief complaints of
Pedal edema since 1 month
Loss of appetite since 2 months
HISTORY OF PRESENT ILLNESS
The patient was apparently asymptomatic 2 years back,during this time his nephew got expired and patient started developing anxiety issues and used to take alcohol daily [previously occasional drinker] and after 15 days of expiry of his nephew patient started developing fever, sudden onset,high grade associated with generalized body pains and during this time, patient was diagnosed with hypertension.
Patient used medication for about 3 months and stopped using it.
Patient was normal upto 10 months, during this 10 months period patient started taking alcohol nearly upto 90 ml daily,and patient had sudden onset fever,high grade with low back and generalized body pains.
Then he was taken to local hospital in Miryalaguda, where he was furthre investigated and diagnosed with CKD.
Patient was on Conservative management from that time.
He was normal and used medication upto 1 year and 2 months back patient started developing loss of appetite,gradual onset associated with pedal edema,pitting type,gradual onset,grade III and not associated with any shortness of breath.
No h/o SOB,palpitations,orthopnea,dyspnea on exertion.
No h/o decreased urine output, and abdominal distention.
PAST HISTORY
H/O Hypertension since 2 years [on Tab.Nicardia 20 mg since 1 year]
H/O CKD since 1 year
Not a known case of DM,Asthma,TB,Epilepsy
PERSONAL HSTORY
Appetite - normal
Mixed diet
Bowels - Regular
Micturition - Normal
Alcohol intake occasionally upto 2 years and from then onwards daily consumes 90ml.
No other addictions
TREATMENT HISTORY
No specific treatment history
FAMILY HISTORY
His father is a known case of Hypertension
DRUG HISTORY
He has been using Tab.Nicardia 20 mg since 1 year for Hypertension.
GENERAL EXAMINATION
Patient was conscious,coherent,cooperative and examined in a well lit room
VITALS
Temperature - 98.2 F
Pulse rate - 84 bpm
Respiratory rate - 22 cpm
BP - 160/100 mmHg
SpO2 - 98% at room air
GRBS - 109 mg%
Weight - 62 kgs
PHYSICAL EXAMINATION
Pallor - present
Icterus - absent
Cyanosis - absent
Clubbing of fingers/toes - absent
Lymphadenopathy - absent
Edema of feet - present,pitting type ,below the knee from 10 days
Malnutrition - absent
dehydration - absent
SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM
INSPECTION
No parasternal heave
JVP not elevated
Apical impulse not visible
No engorged veins
PALPITATIONS
Apex beat felt at 0.5 cm later to the mid clavicular line in 6th intercostal space
All inspectory findings confirmed.
PERCUSSION
Heart borders percussed
AUSCULTATION
S1 and S2 heard
No thrills
No murmurs
RESPIRATORY SYSTEM
BAE +
NVBS +
Trachea is in central position
No dyspnea
No wheezing
PER ABDOMEN
Scaphoid shaped abdomen
Soft
No tenderness
No palpable mass
No hernial orifices
No free fluid
No bruits
Liver and spleen are not palpable
Bowels sounds are heard
CNS
NAD
INVESTIGATIONS
ULTRASOUND
ECG-
LFT-
CBP-
CUE-
RBS-109 mg/ dl
Blood urea-97 mg/ dl
Serum creatinine-7.5 mg/ dl
Serum electrolytes- sodium-137 mEq/L,potassium-4.4 mEq/L,chloride-99 mEq/L,
Serum calcium-9.4 mg/dl
Serum iron- 72 ug/dl
Phosphorus-6.0 mg/dl
PROVISIONAL DIAGNOSIS
CHRONIC RENAL FAILURE
TREATMENT
Tab.Nicardia RSTARD 20 mg PO/BD
Tab Nodosis 500 mg PO/OD
Tab.Orofer XT PO/BD
Tab. Shelcal CT PO/OD
Inj. Erythropoeitin 4000IU [weekly twice]
Inj.Iron Sucrose 10MP in 50 ml NS/IU [weekly once]
Fluid restriction <1.5L/day
Salt restriction < 4 grams /day
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