A 45 yr old male patient with chronic kidney disease
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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
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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