A 55 year old male patient with B/l pedal edema
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A 55yr old male patient,daily wage labourer by occupation came with
C/o Pedal edema since 20 days
Facial puffiness since 20 days
Sob(grade-3) since 20 days
Loss of appetite since 20 days
Decreased urine output since 10 days
A 55yr old male patient was apparently asymptomatic 1 yr back, then he developed weakness of left upper and lower limbs for which he went to the hospital and was diagnosed to have HTN. (Medications prescribed but never taken)
C/o Pedal edema since 20 days - Insidious in onset, gradually progressive from involving ankle to above knee , b/l pitting type
Facial puffiness since 20 days
Sob(grade-3) since 20 days- insidious in onset,sob while talking and walking to washroom
Loss of appetite since 20 days
Decreased urine output since 10 days
Palptations +
No burning micturition
No cough
No chest pain
No orthopnea
No PND
HTN since 1 yr(medications prescribed- but didn't use.)
Non diabetic
No h/o TB, Asthma, epilepsy
Occasional alcohol consumer
Occasional tobacco abuser
No NSAID abuse
O/E:
Temp- afebrile to touch
BP-160/80mmhg
Pr-89/min
Spo2-96% on RA
Rr-23/min
Palor- present
No- icterus, cyanosis, lymphadenopathy
B/l-pedal edema present
Cvs-S1S2 heard,
Jvp raised
apex beat displaced 2cm lateral to mid clavicular line in 5th intercoastal
RS- BAE+, NVBS
P/A: distended, soft, non tender
CNS: NAD
2d echo
Diagnosis:
Chronic kidney disease with HFPEF with dilated cardiomyopathy.
Ascitic fluid tap analysis:
Cell count- 95 cells
80% lymphocytes, 20% neutrophils
Ascitic fluid sugar: 125
Ascitic fluid total proteins: 2.1
Ascitic fluid albumin: 1.54
Ascitic fluid amylase: 160.9
Serum Albumin: 3.61
SAAG: 2.07
Fluid restriction < 1L/day
Salt restriction <2-4 gm/ day
TAB. LASIX 40 MG PO BD
TAB. NODOSIS 500 MG PO BD
TAB OROFER XT PO BD
TAB SHELCAL PO OD
TAB NICARDIA 10 MG PO BD
TAB. DOLO 650 MG PO BD
MONITOR VITALS
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