A 45 yr old male patient with nephrotic syndrome
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Date of admission :30th October
A 45year old male patient welder by occupation came to the OPD with body swellings,body pains and SOB since 6months
History of present illness
Patient was apparently asymptomatic 18months back.In the month of march he experienced seizures associated with leg swellings(nearly 20bouts of seizures in one day)He then was admitted in Mamatha and recovered.He experienced 2 episodes of seizures 6months back.The symptoms of patient during seizures are dizziness,tingling and numbness.
History of shortness of breath (Grade-4)since 3years.
Pedal edema is present-pitting type since 18months
Patient developed anasarca with facial puffiness for which he visited the hospital and was diagnosed with nephrotic syndrome.
Patient complaints of decreased urine output
Patient complaints of low back pain(pricking type) radiating to the side and to the lower limbs.
Patient complaints of pain at knee and ankle joint.
History of weight loss
Patient complaints of loose stools.(On Sunday -31th October at 3:00-7:00am-4episodes and Monday morning at 3:00-9-00am 3episodes)
History of past illness
Patient was known case of diabetes since 6years and hypertension since 6months.
Personal history
No loss of appetite
Inadequate sleep
History of alcohol consumption(Imperial blue brand) occasionally since 10years
Patient has habit of chewing pan since 2years.
No habit of smoking.
Family history
No relevant history found
General Examination
Patient was conscious,cooperate and coherent at the time of joining
No pallor
No icterus
No cyanosis
No clubbing
Pedal edema is present
No generalized lymphadenopathy
SACRAL EDEMA
VITALS:
Temperature-98.5F
Pulse-82 beats/min
Bp-120/80mm Hg
Respiration rate-20 /min
SYSTEMIC EXAMINATION
CVS
No thrills
S1 S2 heard
No murmurs
RESPIRATORY SYSTEM
No dyspnoea
No wheeze
Position of trachea-central
Breath sounds-vesicular
ABDOMEN
Shape of abdomen-scaphoid
No tenderness
Bowel sounds-present
No bruits
CNS
- Patient is conscious
- Speech is present
- Reflexes are normal
INVESTIGATIONS
MRI BRAIN
SERUM CREATININE
SERUM ELECTROLYTES
ECG
PROVISIONAL DIAGNOSIS
Nephrotic syndrome
TREATMENT
Tab Ecosprin AV/Po/HS
Tab Livogen Po/OD
Tab Nodosis 500mg/Po/BD
Tab PAN 40mg Po/OD
Fluid restrictions <2litres/day
Salt restrictions <2g/day
Tab CELGLIM Po/OD
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