65 year old male with Bipedal edema and shortness of breath
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Here is a case i have seen:
65 year old male who was a farmer and stopped working 2yrs back and gave his farm to his sons. He is now dependent on his 4sons for 2000 rs monthly.
He came to the OPD with chief complaints of
bilateral pedal edema since 20days and
Shortness of breath since 20days.
Patient was apparently asymptomatic 10years back then developed bilateral knee pain for which NSAID treatment was given by RMP. Then gives a history of cataract surgery for right eye 10years ago followed by? Endophthalmitis /optic neuritis and complete loss of vision in right eye.
Then 1 year back he had a road Traffic accident for which surgery(? Intramedullary nail insitu) was done for ?hip fracture In nalgonda govt hospital. There he was diagnosed with Renal problem(reports not available) and did not used any medications for that.
9 months back patient gives history of taking 2injections of? Intraarticular steroid
Now presented with the complaints of bilateral pedal edema since 20days, pitting+, gradually progressive since 20days, no aggregating and relieving factors.
C/O Shortness of breath grade 3,gradually progressive, no aggrevating and relieving factors.
C/O decreased urine output since 10days,decreased frequency , associated with burning micturation on and off
C/o fever 4days back lasted for 1day relieved on medication. No h/o cold, cough loose stools, vomitings.
Not a k/c/o DM, HTN, CAD, CVA, TB, asthma
History of alcohol intake occasionally since 40years and stopped taking it since 8months and gives history of smoking for 20years and stopped smoking since 30years
He takes vegetarian diet with decreased appetite, his bowel and bladder movements regular.
O/E
Patient is conscious coherent cooperative
Pallor present
No Icterus, cyanosis, koilonychia,Lymphadenopathy
Pedal edema + which is pitting type
Vitals:
Temp:98.5 F,
RR 26cycles/min,
BP:100/70mmHg,
PR:96/min, regular, normal volume
SpO2:97% on RA
Systemic examination:
CVS:
s1 s2 +
no murmurs
RS:
Bilateral air entry present
Normal vesicular breath sounds
decreased breath sounds in right ISA
CNS:
all higher motor functions are normal
Cranial nerves intact
Sensory system normal
Motor system normal
Cerebellar signs normal
No meningeal signs
P/A:
soft
Non tender
no organomegaly
bowel sounds heard
Investigations:
ECG
SERUM ALBUMIN:2.7
PROVISONAL DIAGNOSIS:
CKD stage IV, secondary to NSAID abuse
Anemia of chronic disease
Mild Right pleural effusion
DAY2
65 year old male
CKD stage IV secondary to NSAID abuse
Anemia of chronic disease
Rt sided mild pleural effusion
No fresh complains
O/E pt c/c
I/O 800/600
Grbs:90mg/dl at 8am
Pedal edema subsiding
PR 96/min
BP 100/60mmhg
Cvs s1s2 +
Rs:BAE +, NVBS, decreased BS right ISA
P/A soft, NT
CNS:no FND
On inj Lasix 20mg Iv BD
Strict I/O charting
DAY3
65 year old male
CKD stage IV secondary to NSAID abuse
Anemia of chronic disease
Rt sided mild pleural effusion
No fresh complains
O/E pt c/c
I/O 1600/1400
Grbs:94mg/dl at 6am
Pedal edema subsiding
PR 84/min
BP 100/80mmhg
Cvs s1s2 +
Rs:BAE +, NVBS, decreased BS right ISA
P/A soft, NT
CNS:no FND
On inj Lasix 20mg Iv BD
Strict I/O charting
Plan for pleural fluid analysis
Reports from pleural fluid analysis
SERUM LDH 230
PLEURAL LDH 329
SEEUM PROTEIN 4.7
PLEURAL PROTEIN 2.3
PLEURAL SUGAR:55
PLEURAL CYTOLOGY
Total counts 208cells
Wbc counts 40% neutrophils , 60% lymphocytes
Rbc cells Plenty
According to lights criteria: it is exudative
DAY 4
65 year old male
CKD stage IV secondary to NSAID abuse
Anemia of chronic disease
Rt sided mild pleural effusion
C/o burning micturition
Pain in the right side is chest
Fever spikes
10pm - 101F
12am - 100F
8:00 am - 98.4F
O/E pt c/c
I/O 1100/1300
Grbs:100mg/dl at 8:00am
Pedal edema subsiding
PR 78/min
BP 100/80mmhg
Cvs s1s2 +
Rs:BAE +, NVBS,
P/A soft, NT
CNS: HMF Intact
Plan for discharge
TREATMENT GIVEN:
INJ LASIX 20MG IV BD
TAB PANTOP 40MG PO OD
SYRUP CITRALKE 15ML IN 1 GLASS OF WATER H/S
TAB OROFER XT BD
TAB SHELCAL 500MG PO OD
TAB ALPHA D3 O.25MCG PO OD
TAB NEUROBION FORTE OD
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