58 year old male with pedal edema? CKD stage 4? diabetic nephropathy.anemia secondary to CKD ( 2 degree to chronic smooking )K/C/O DM 2 since 7 yrs.

This is an online E log book to discuss our patients deidentified health data shared after taking his/her/guardians signed informed consent.

Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those 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 the comment box is welcome.

Here is a case I have seen : 

Unit 6 admission 

AMC 30/1/21

Dr. Radha PGY3

Dr. Rashmitha PGY1 

Dr. Vinay PGY1

Interns

Swarna 

Juveria

Divya

Nikhil

Manivarma

58 yr old male from suryapet tailor by occupation came with chief complaint of pedal edema since 1 week,F/b upperlimb edema since 1 week with 1 day gap he developed facial puffiness since 2 days SOB grade 2 since 1 month. 

Pt was apparently asymptomatic 7 yrs back,pt had initially a small trauma to his right little toe 7 yrs back not healing eventhough on continuous medications and on investigating he was diagnosed as DM 2 and toe- distal phalanx was dysarticulated and on treatment metformin 500 mg/OD  and after 1 yr he had clo irregular control of sugar and went to local hospital for which metformin  500 mg /OD was given. Similar complaints of uncontrolled sugar once a year till now. Again 6 months back one day Pt observed pedal edema early morning followed by upperlimb edema followed by facial puffiness with a day gap. Went to local medical shop took some medication on his own,only when edema appear and then since 1 week pt C/O pedal edema with facial puffiness with edema over upper limbs and abdomen. Came to kamineni for further follow up and investigations. 

H/O jaundice 20 yrs back for which he used herbal medication.

C/O cough - dry only on smooking-beedis. 

No H/O fever and cold 

No C/O chest pain palpitations ,syncopal attacks ,orthopnea.

PND present since 1 week. 

No C/O burning micturition loose stools,constipation .

K/C/O diabetes since 7 yrs - metformin 500 mg po/od.

No H/o HTN,TB,Epilepsy Asthma .

O/E:

Patient is conscious coherent and cooperative

Temperature - afebrile

PA -soft nontender 

RS -BAE present clear coarse crepitations in B/L IAA, ISA.

CVS -S1S2 heard no 

murmurs jvp normal. 

CNS- HMF intact

Provisional diagnosis : chronic anemia secondary to chronic kidney disease stage 4 with ?COPD (2 degree to chronic smoking )

Investigations -


ECG



Treatment day 1: 
1. Fluid restriction <1.5L/day and salt intake <2g/day
2 Tab. PAN 40mg PO BBF
3. Inj. LASIX 40mg IV BD
4. Monitor GRBS 6th hourly
5.Monitor BP/ PR / RR
6. Inj. HAI S/C TID 

Treatment day 2:
1.Fluid restrictions,<1.5 L/Day and salt intake <2g/day
2.Tab . PAN 40mg PO BBF
3. Inj. LASIX 40mg IV TID
4. Monitor GRBS 6th hourly
5.Monitor BP/ PR / RR
6. Inj. HAI S/C TID 
7. ProteinX powder 2 tsp in a glass of milk TID
8.Cap.alfa D3 0.25 mcg PO OD 
9. Tab. SHELCAL 500mg PO TID
10. Tab. NODOSIS 550mg PO BD

Treatment day 3:
1.Fluid restriction <1.5L/ day
2.salt restriction < 2 gm/ day
3.Tab . PAN 40mg PO BBF
4. Inj. LASIX 40mg IV TID
5. Monitor GRBS 6th hourly
6.Monitor BP/ PR / RR
7. Inj. HAI S/C TID 
8. ProteinX powder 2 tsp in a glass of milk TID
9.Cap.alfa D3 0.25 mcg PO OD 
10. Tab. SHELCAL 500mg PO TID
11. Tab. NODOSIS 550mg PO BD.

Treatment day 4:
1.Fluid restriction <1.5L/ day
2.salt restriction < 2 gm/ day
3.Tab . PAN 40mg PO BBF
4. Inj. LASIX 40mg IV TID
5. Monitor GRBS 6th hourly
6.Monitor BP/ PR / RR
7. Inj. HAI S/C TID 
8. ProteinX powder 2 tsp in a glass of milk TID
9.Cap.alfa D3 0.25 mcg PO OD 
10. Tab. SHELCAL 500mg PO TID
11. Tab. NODOSIS 550mg PO BD
12.Tab.Taxim 200mg PO/BD

Treatment day 5:
1.Fluid restriction <1.5L/ day
2.salt restriction < 2 gm/ day
3. Tab. LASIX 40mg IV TID
4. Monitor GRBS 6th hourly
5..Tab. Glipizide 5 mg/PO/OD
6. Inj. HAI S/C TID 
7. ProteinX powder 2 tsp in a glass of milk TID
8.Cap.alfa D3 0.25 mcg PO OD 
9. Tab. SHELCAL 500mg PO TID
10. Tab. NODOSIS 550mg PO BD
11.Tab.Taxim 200mg PO/BD
12.Tab.telma 40mg PO/OD.
13. IV Iron sucrose 1 amp in 100 ml NS /IV over 30 mins after test dose. 

Treatment day 6:
1.Fluid restriction <1.5L/ day
2.salt restriction < 2 gm/ day
3. Tab. LASIX 40mg IV TID
4. Monitor GRBS 6th hourly
5..Tab. Glipizide 5 mg/PO/OD
6. Syp ascoril P 10 ml PO / TID
7. ProteinX powder 2 tsp in a glass of milk TID
8.Cap.alfa D3 0.25 mcg PO OD 
9. Tab. SHELCAL 500mg PO TID
10. Tab. NODOSIS 550mg PO BD
11.Tab.Taxim 200mg PO/BD
12.Tab.telma 40mg PO/OD.


Popular posts from this blog

?LEPTOSPIROSIS WITH THROMBOCYTOPENIA,JAUNDICE,NON OLIGURIC RENAL FAILURE

Image
This is an online E log book to discuss our patients deidentified health data shared after taking his/her/guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those 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 the comment box is welcome. Here is a case I have seen: Unit 6 admission : Swarna juveria Nikhil reddy Divya Manivarma Dr. Hareen (SR) Dr. Vinay PgY1 Dr. Vaishnavi Pgy2 Dr. Praneeth PgY3 37 yrs old male patient, Who is a daily wage labourer ,came with chief complaint of fever and generalized weakness since 5 days and loss of appetite since 4 days.  History of present illness : Patient was apparently asymptomatic 5 days back then he complaints of fever high grade. Fever associated with chills on and off 2-3 times/ day re
Read more

chronic decompensated liver disease secondary to alcohlolism

Unit 6: Case admitted in male ward on 6/2/2021. Interns  M. Swarna K. Nikhil reddy K. Divya  B.Manivarma Juveria   Dr. Vinay(pgy1) Dr. Rashmitha(pgy2) Dr. A. Vaishnavi (pgy2)  Dr.  Sai Radha(pgy3) Dr. Hareen (SR) Dr.Praveen Naik( asst.proff) A 37 year old male resident of achanpally, who's a chronic alcoholic since 5 years,consumes brandy 80 ml/day,last alcohol intake is 9 days back came with complaints of Right scrotal swelling 9 days back,got treated by a local doctor but not relieved.After 2 days patient noticed pedal edema, pitting type upto knee.He also complained of pain in the epigastric region, burning type associated with abdominal distension and shortness of breath.Shortness of breath increased on sitting but not on walking.Orthopnea absent.Tremors of both hands since 9 days.H/O of tremors 5 years ago whenever he stopped taking alcohol.No H/O of hemetemesis,Malena,loose stools, jaundice.No h/o oliguria, cough, fever, palpitations. Past history-He gave a h/o burning sensat
Read more