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A 40yr female came with the complaints of SOB since 1 day

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 40yr female came with the complaints of SOB since 1 day

HOPI 

Patient was apparently asymptomatic 6months back and then developed b/l pedal edema and took medications 

2 months back symptoms increased and sob and went to nlg admitted for 3 days for sob grade 4 

C/o nausea and vomiting since 2 months- continuous, water in consistency, non bilious , non projectile 

C/o Facial swelling and peri orbital swelling started 2 months back and nlg Dr's advised dialysis and patient went to Gandhi hospital and got admitted but dialysis sessions delayed so they went to NIMS hsptl and got admitted for 2 days and dialysis 1 session done and got discharged

And then after 3 days symptoms started again and went to NIMS again and Dr adviced for dialysis sessions twice /month 5 sessions of dialysis done 

And discharged and came to our hospital. 

C/o SOB -Grade 4

C/o vomitings- continuous , watery in consistency,non bilious,non projectile since 2months 

Past history: 

K/c/o HTN 5 yrs and on telma 40mg

K/c/o DM 12yrs and on Glimiperide 1mg+ metformin 500mg 


Personal history: 

Diet mixed 

Appetite decreased since 1month 

Sleep Adequate

Bowel and bladder regular 

No addictions 


General examination

Pat is c/c/c well oriented to time place person 

Moderately built and nourished 

Pallor present 

B/L Pedal edema present  

Facial swelling present 

No signs of icterus cyanosis clubbing lymphadenopathy generalized edema 


 


 


 


 


 


 


 


Vitals : 

Temperature 97.6 

PR 112

 BP 180/90 

Spo2 96 at ra 

Grbs 213 mg/dl 

Systemic examination

CVS S1 S2 Heard no murmurs

RS BAE Present NVBS heard 

Per abd : 

Inspection-

Shape of the abdomen:Distended 

Flanks:Free 

Umbilicus:center,oval shape 

Skin-dry scaly ,no sinuses,scars,striae 

No dilated viens 

Abdominal wall moves with respiration 

No hernial orifices 

Palpation:

No local rise of temperature,no tenderness.All inspectory findings are confirmed by palpation. 

Liver:Not palpable,Non tender,no hepatomegaly

Spleen:Not palpable,non tender,no splenomegaly 

Kidney:Non tender and not palpable 

No other palpable swellings

CNS : NFND 

Provisional diagnosis: 

CKD ON MHD with K/C/O HTN AND DM -TYPE 2 with ANAEMIA 

Investigations: 









Treatment: 

TAB.NICARDIA 10MG PO/TID

TAB.ARKAMINE 0.1MG PO/OD 

INJ.HAI SC TID  

TAB.NODOSIS 500MG PO/BD 

TAB.SHELCAL 500MG PO/OD 

TAB.OROFER XT PO/OD 

TAB.DOLO 650MG PO/SOS 


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