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45 yr old male with shortness of breath




Chief complaints::  A   45 year old man came to the casualty complaining of  shortness of breath since 10 days.and swelling of lower limbs since 10 days

History of present illness:::

..He was apparently asymptomatic six years ago, then he had an episode of fever for which was admitted to the hospital.
. He was diagnosed with malaria.
.He was diagnosed with Diabetes Mellitus as well.
Then, 3 years ago, he had an another episode of fever for which he consulted a physician 
He was found to have Viral Pyrexia and was diagnosed with Hypertension.
Then around 1 year ago , one morning he had an episode of weakness of the right arm for which he was advised to undergo physiotherapy. 
After 6 months of physiotherapy, the family thought he might get dependent on it so discountined.
On September 2nd 2021, he came to the casualty with complaints of generalised swelling and shortness of breath since 10 days.
Which was insidious in.onset gradually progressive from grade 2 to 3 more common white eating not associated with orthopnea and pnd.
Swelling of both lower limbs at ankle joint upto knee level gradual progressive no aggrevating and relieving factors
He was diagnosed with Acute Kidney Injury with Serim Creatinine value being 9.
He is undergoing regular Hemodialysis since then.
His last dialysis was on 10 January, 2022

Past history::

No history of similar complaints in past
H/o diabetes mellitus since 6yrs
H/o hypertension since 3yrs
H/o hypothyroidism since 3yrs

No h/o Tuberculosis,epilepsy,coronary artery diseases

Personal history:::

Appetite:normal
Diet:mixed
Bowel and bladder:regular
Sleep: adequate
Addictions::occasional alcoholand toddy drinker

Family history::
Not significant

Treatment.history::
Tab.metxl 50
Tab.Thyronorm 50mcg
Inj.insulin 10units bd

General examination
...Patient was consious coherent and cooperative 
..Consent taken
..Built: moderate
..Nourishment:moderate

No signs of icterus,cyanosis,koilonychia ,generalized LYMPHADENOPATHY
Pallor present
Pedal edema present
Jvp not raised

Vitals::
Temperature - Afebrile
BP - 110/80mm Hg
PR - 82bpm
RR - 18/min
SpO2 - 99% at room air

Systemic examination:::

Respiratory system..

Shape of chest..b/l symmetrical
Trachea..central
Normal vesicular breath sounds heard
No wheeze
On percussion resonant on  all areas of chest

Cardio vascular system::

 S1 S2 present
No murmurs heard
Apex beat heard in 5th ics 
No parasternal heave


Perabdomen::

soft, non tender, obese with Abdominal distension
No tenderness
No palpable mass
Liver ,spleen non palpable
No fluid thrill 

Central nervous system::

Consious
Speech normal
No neck stiffness
Kerning sign .negative
Reflexes..normal
Cranial nerves ..normal
Sensory and motor system normal





Investigations::

RFT :
Urea - 56mg/dl
Creatinine - 6.8mg/dl
Uric acid - 4.9mg/dl
Na - 143
K - 3.5
Cl - 93

LFT :
TB - 0.55mg/dl
DB - 0.16mg/dl
SGOT - 17
SGPT - 10
ALP - 210
Albumin - 3.2gm/dl
Total proteins..6.6gm/dl

Serology - Hiv,HBSAg  ..Negative

ECG..




Provisional Diagnosis : CKD on MHD

Treatment::
Tab.cilindipine od
Tab.Metxl 50 od
Tab torsemide od
Tab orofer XT od
Tab sodium bicarbonate




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