A 45 yr old male patient with chronic kidney disease

 This is an online elog book to discuss our patients de-identified health data shared after taking his/her or guardians signed informed consent.Here,we discuss our individual patients problem through series of input from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.

Chief complaint 

A 45 year old male patient complaints of decreased urine output,swelling in the legs since 3years,SOB since 5days

History of present illness 

Patient was apparently asymptomatic 3years back.He went to local doctor complaining of weight gain and generalized edma,pitting type.He is on dialysis and medication since 3years.Suddenly he developed SOB since 5days which aggrevates on lying down position.

Past history 

He is a known case of hypertension since 2years,No-asthma,diabetes mellitus,tuberculosis,surgeries

Personal history 

Diet-vegetarian 

Normal apetite

Bowel and bladder movements-regular

Addictions-occasional intake of alcohol 

Family history 

No similar complaints in family 

General Examination 

Patient was conscious,cooperative,coherent ,well oriented 

Moderately built and well nourished 

No pallor ,icterus,cyanosis,clubbing ,lymphadenopathy,dehydration

Presence of bipedal edema

Temperature-98.4°

PR -86/min 

RR-22cycles/min

Spo2-96%

SYSTEMIC EXAMINATION :

CVS-S1 ,S2heard

No thrills

Ni cardiac murmurs

RESPIRATORY SYSTEM :

Dyspnea present 

No wheezing 

Position of  trachea -central 

Breath sounds -vesicular

PER ABDOMEN :

Shape of abdomen -scaphoid 

Non tenderness ,no palpable mass,normal hernial orifices

CNS:

No focal neurological defecits 

PROVISIONAL DIAGNOSIS:

Chronic kidney disease on maintenance of haemodialysis

Pitting type of edema


INVESTIGATIONS:

COMPLETE BLOOD PICTURE:

Haemoglobin-8.1gm/dl

TLC -6100cells/micro lit

Platelet count-1.47lakhs/cu mm

Smear-normocytic normochromic anemia

HBs Ag -RAPID TEST 


HIV-TEST

SERUM ELECTROLYTES 
SERUM CREATININE 
BLOOD UREA
ANTI HCV ANTIBODIES

TREATMENT 

Fluid restriction <2litres/day

Salt restriction <2g/day

TAB NICARDIA 10mg/bd

TAB LASIX 40mg/bd

TAB NODOSIS-550mg/PO/OD

TAB SELCAL 500mg/PO/OD

TAB OROFER PO/OD

QUESTIONS

Reason for sudden development of SOB??

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