A 61 Yr old male with pedal edema

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A 61 Yr old male, farmer by occupation, resident of Suryapet came to OPD on 2 nd Nov 2021

C/O : 1) swelling on both legs since 20 days

          2) shortness of breath since 5 days

HOPI : Patient was apparently asymptomatic 20 days back, then he developed

  • Pedal edema : insidious in onset, gradually progressed from just above the ankle to knee level. Right side more compared to left. No aggravating factor, not relieved on medication.
  • Not associated with fever.
  • Associated with shortness of breath which is grade 4 acc to NYHA , orthopnea present, no PND.
  • Patient has reduced urine output since 4 months.
Past history :

  • K/C/O hypertension since 15 years 
  • Diagnosed with CKD 4 years back
  • Went to NIMS with c/o anorexia, dyspepsia, reduced sleep and Sr. Creatinine was found to be 2 mg/dl. Put on dialysis after that. 
  • No history of diabetes, asthma, TB, heart disease. 
  • No H/O any surgeries 
Treatment history:
  • Patient was on medication for CKD for 2 1/2 years after diagnosis
  • He is on dialysis since sept 2020 twice weekly. 
  • He was being treated in nims hospital
Personal history :
  • Diet.              :  mixed 
  • Appetite.        :  reduced 
  • Bowel.          :  regular 
  • Bladder.       :  reduced output since 4 Month
  • Addictions   :  absent
  • Allergies      :  absent
Family history :
  • No h/o CKD in the family

General examination :

Patient is conscious, coherent, cooperative 
Moderate built and moderate nourished 

  • Pallor.            : present 
  • Icterus           : absent 
  • Cyanosis        : absent
  • Clubbing        : absent 
  • Pedal edema : on right side - till the knee                                on left side - till the ankle 
  • Lymphadenopathy : absent 


Vitals : 
  • Pulse rate             :  84 bpm 
  • Temperature       :  98.2 F
  • Respiratory rate  :  20 cpm
  • Blood pressure    :  130/80 mm hg 
  • Spo2.                     :   99% at RA 
Systemic examination :

Respiratory system: 

Inspection : 

  • Trachea                         :  central
  • Shape of chest             :  normal
  • Movements.                 :  equal on both sides
  • Scars, sinuses.             :  absent
Palpation : 
  • Trachea.                         : central
  •  Movements of chest   : equal on both sides
  • Tactile vocal fremitus : equal on both sides 
Percussion :   resonant in all areas

Auscultation : crepitations heard in infra          mammary areas on both sides 

Abdomen examination : 
  • Soft, non tender 
  • No organomegaly
  • Bowel sounds present
CNS examination : 
  • Sensory system : normal 
  • Motor system : normal
  • Cranial nerves : normal 
CVS examination : 
  • Heart sounds : s1and s2 heard 

INVESTIGATIONS : 


Provisional Diagnosis : CKD on maintainance hemodialysis 

Treatment : 
  • Fluid restriction   : < 1.5 l / day 
  • Salt restriction      : <2.4 gm/day
  • Inj. Lasix                : 40 mg I. V BD
  • Tab nodosis           : 500 mg po BD 
  • Tab Bio D 3.           : 0.25 mg po OD
  • Tab shelcal ct        : 500 mg po OD 
  • Tab orofer             : po BD 
  • Inj. Erythropoeitin : S. C weekly twice 





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