A 65 year old male with anasarca

-


65 year old male with anasarca 




 A 65 Yr old male resident of narketpally, vro by occupation came to hospital on 8 November with

C/O :

  • B/l pedal edema since 2 weeks
  • Shortness of breath since 2 weeks
Hopi :

  • Patient was apparently asymptomatic 3 yrs back then he developed hemiparesis on right side and he was put on antiplatelet
  • Then he was diagnosed with diabetes and hypertension 
  • He also had complains of b/l pedal edema after which they diagnosed him with CKD


  • Now,  2 weeks back he started developing edema which is insidious onset, gradually progressive, associated with pain. 
  • It started on legs, then progressed to hands abdomen and face in that order. 
  • Edema aggravated on walking and not relieved on medication. 
  • It is associated with shortness of breath which is grade 4 on NYHA classification 
  • Associated with decreased urine output 
  • No associated fever, chest pain, cold 
Past history : 
  • H/o diabetes mellitus since 3 years 
  • H/o HTN since 1 1 /2  years 
  • H/o kidney disease since 3 years 
  • No H / o TB, Asthma, epilepsy. 
Drug history : 
  • Human actrapid inj for DM 
Surgical history :
  • No H/o surgeries 
Personal history :
  • Diet            : mixed 
  • Apetite      : reduced 
  • Bowel.       : regular
  • Bladder.    : reduced 
  • Addictions : used to consume alcohol 3years back 
General examination : 
  • Pallor - present 
  • Icterus - absent 
  • Cyanosis - absent 
  • Clubbing - absent 
  • Lymphadenopathy - absent 
  • Pedal edema - present 
Systemic examination : 
  1. CVS examination : 
  • Inspection : JVP is raised, normal shape and movements of the chest. 
  • Palpation : apex beat - 5 th intercostal space, no abnormal pulsations felt.
  •  Auscultation : s1 and s2 heard, no murmurs
    2. Abdominal examination : 
  • Inspection : distended abdomen, umbilicus is crescent shape, movement - equal in all quadrants. 
  • Palpation : liver, spleen not palpable, fluid thrill present 
  • Percussion : no shifting dullness 
  • Auscultation : Bowel sounds present, no bruit 
     3. Respiratory system : 
  • Normal vesicular breath sounds 






Investigations : 












Diagnosis :  Acute left Heart failure and Chronic kidney disease on MHD 

Treatment:

Fluid restriction 

Inj Lasix 40 mg / IV / Stat followed by inj Lasix 20 mg @ 2.5 ml / hr

Inj Pantop 40 mg IV/OD

Inj Zofer 4 mg IV/SOS 

Nebulisation with duolin and budecort 8th hourly 

Tab Ecosprin AV ( 75/ 20 ) PO/ H/S

Tab Amlong 10 mg PO/ H/S

Inj HAI S/C pre meal acc to sliding scale 

Weight monitoring daily 

Foleys catherisation done 


Pleural tap done I/v/o Rt sided gross pleural effusion


Pleural fluid analysis:
Sugar- 198
Protein- 0.7
LDH- 154


Chest x ray : 
After pleural tap : 




Comments

Post a Comment

Popular posts from this blog

A 14 year old female with SOB snd fever

-
Image
    This is online E log book to discuss out patients de-identified health data shared after taking his / her guardian`s informed consent. Here we discuss our individual patient`s problems through series of inputs from available global online community of experts with an aim to solve patients clinical problems with collective current best evidence based inputs.       This E log book also reflects my patient centered online learning portfolio and your valuable inputs on comments box is welcome . Note:  The cases have been shared after taking consent from the patient/guardian. All  names and other identifiers have been removed to secure and respect the privacy of the patient and the family. Consent:   An informed consent has been taken from the patient in the presence of the family attenders and other witnesses as well and the document has been conserved securely for future references Patient came to casualty with C/O: 1) Shortness of brea...
Read more

Medicine Internal assessment

-
Image
10 Marks questions: Question - 1  Define bone density, how is it measured? What are the causes, clinical features,diagnosis and management of osteoporosis? (1+2+2+2+3) https://rishik37.blogspot.com/ 2021/08/gm-elog-case-7.html  ( 31st aug, 3:39pm) Question - 2   What is myxedema coma? Describe its clinical features , diagnosis and treatment of myxedema coma (2+2+2+4)   http://mahithguduri63. blogspot.com/2021/09/myxedema- coma.html(  22nd sep, 9:36am) 4 marks questions : Question - 3  What is the diagnostic approach of young onset hypertension and it’s treatment. http://keerthykasa80.blogspot. com/2021/09/a-35-year-old- female-with-hypertensive.html( 22nd  sep, 10:24am ) Question - 4  How do you clinically localize the anatomical level of lesion in spinal cord diseases. http://sowmya9.blogspot.com/ 2021/08/21-year-old-with.html( 2nd  sep, 7:27pm)   Question - 5  C auses,diagnosis and treatment of atrial fibrillation. (Shared on 25th...
Read more

A 56 year old male with altered sensorium and CKD

-
Image
A 56 Yr old male R/o Miryalaguda,  dialy labourer by occupation came to hospital on 19 November 2021 for his dialysis  Hopi :  Patient was apparently asymptomatic 2 years back when he was diagnosed with CKD when he had c/o bilateral pedal edema  Patient has come to the hospital for his regular dialysis session on 19 Nov, after running regular tests he was told he requires blood transfusion.  Dialysis session was delayed due to blood transfusion ( the last dialysis session was 14 days back).  Patient developed fever since 3 days associated with chills and rigors and increased during night. No associated vomiting, diarrhea, shortness of breath.  Patient's relative noticed slurring of speech and not responding to commands since 1 day  Past history :  H/o hypertension and diabetes mellitus since 4 years.  Diagnosed with CKD 2 years back, for which he is on dialysis twice a week  H/o blood transfusions 2 times in the past, recent one is ...
Read more