52F ACUTE PULMONARY EDEMA CHRONIC RENAL FAILURE HTN 1MONTH DM2 5YRS

Diagnosis -ACUTE PULMONARY EDEMA
CHRONIC RENAL FAILURE
HYPERTENSION SINCE 1MONTH
DIABETES MELLITUS SINCE 5YEARS


CC -C/O FACIAL PUFFINESS AND PEDAL EDEMA SINCE IMONTH

HOPIS

PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO THEN SHE DEVELOPED FACIALPUFFINESS AND PEDAL EDEMA SINCE I MONTH INSIDIOUS ONSET GRADUALLY PROGRESSIVE WITH SOB GRADE III FOR WHICH SHE USED OUTSIDE MEDICATION AND PARTIALLY RELIVED.
DECREASED URINE OUTPUT SINCE 2DAYS
FEVER SINCE 2DAYS NOT ASSOCIATED WITH CHILLS AND RIGORS,NO DIURNAL VARIATION.
COUGH NOT ASSOCIATED WITH EXPECTORATION .

PAST HISTORY - DIABETES MELLITUS SINCE 5YEARS.
HYPERTENSION SINCE 1MONTH
NO OTHER COMORBIDITIES

GENERAL EXAMINATION 
PT IS C/C/C
BP-140/80MMHG
PR-86BPM
SPO2-99 % on RA
RR-18CPM

SYSTEMIC EXAMINATION

CVS-S1S2+,NO MURMURS
RS -BAE +, BILATERAL DIFFUSE CREPTS + IN ALL REGIONS

INVESTIGATIONS 
RFT -4/01/2024
UREA  158
CREAT 6.6
NA + 133
K+.  5.3
CL- 101
HEMOGRAM 


HAEMOGLOBIN 9.9gm/dl
TOTAL COUNT 16,100cells/cumm

%

20-40

Light Micr

EOSINOPHILS

00

%

01-06

Light Micr

MONOCYTES

02

%

02-10

Light Micr

BASOPHILS

00

%

0-2

Light Micr

PCV

29.1

vol%

36-46

Calculation

MCV

83.1

fl

83-101

Calculation

MCH

28.3

27-32

Calculation

pg

MCHC

34.0

%

31.5-34.5

Calculation

RDW-CV

15.0

%

11.6-14.0

Histogram

RDW-SD

45.7

39.0-46.0

Histogram

RBC COUNT

3.50

millions/cumm



-LIVER -NORMAL SIZE AND ECHO TEXTURE,NO IHBRD 
RT KIDNEY-6.2X3.1CMS, DECREASED S AND RAISED ECHOGENECITY
LT KIDNEY-7.8X4.1CMS NS/RAISED ECHOGENECITY
USG ABDOMEN AND PELVIS -RIGHT GRADE III RPD CHANGES
LEFT GRADE I RPD CHANGES
GRADE 1 FATTY LIVER
B/L PLEURAL EFFUSION WITH RIGHT UNDERLYING COLLPASE

2D ECHO:
CONCENTRIC LVH,NO RWMA
MODERATE MR+, MODERATE AR+, MODERATE TR+
SCLEROTIC AV,NO AS/MS
GOOD LV SYSTOLIC FUNCTION, NO DIASTOLIC DYSFUNCTION
MINIMAL PE POSITIVE, PLEURAL EFFUSION POSITIVE
IVC SIZE 1.28CMS COLLAPSING
ALL CHAMBERS DILATED
EF-62%
GOOD LV SYSTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION



TREATMENT GIVEN -
INJ.LASIX 40MG IV STAT







ADVICE AT DISCHARGE
TAB NICARDIA 10MG PO/BD

INJ HAI ACC TO GRBS SC 6U -6U -4U

INJ.ERYTHROPOITIN 4000SC ONCE WEEKLY 

TAB NODOSIS 500MG PO BD

TAB SHELCAL CT PO/OD 

TAB OROFER XT PO OD

TAB BIO -D3 PO ONCE A WEEK

Comments

Post a Comment

Popular posts from this blog

THESIS

TITLE -OUTCOMES OF ANEMIA IN PATIENTS OF CHRONIC KIDNEY DISEASE.     INTRODUCTION -          Anemia is a major complication affecting chronic kidney disease patients accounting to increased cardiovascular diseases ,decreased appetite with progressive malnutrition and major cause for poor outcomes including    higher rates of mortality. AIM - To evaluate outcomes of anemia in patients with chronic kidney disease OBJECTIVES 1. To assess the haemotological profile and serum iron indices in chronic kidney disease. 2. To assess therapeutic uncertanities in managing patients with anemia of chronic renal failure.  3. To assess the outcomes in terms of mortality. TYPE OF ATUDY DESIGN - Prospective Observational Qualitative study INCLUSION CRITERIA  1.Hb <13mg/dl in men and Hb < 12mg/dl in women. 2. Greater than 18 Years age of both genders. 3.GFR <60 ml/min/1.73sq.mts >3months. 4. Informed Consent from each pat...
Read more

jankammma 73y female -202433096

 73 YEAR OLD FEMALE RESIDENT OF NALGONDA WAS BROUGHT TO THE CASUALTY WITH C/O SWELLING OF BOTH HANDS SINCE 4 DAYS C/O DIFFICULTY SWALLOWING SINCE 1 DAY HISTORY OF PRESENTING ILLNESS PATIENT WAS APPARENTLY ASYPMTOMATIC UNTIL 4 DAYS AGO THEN HAD  C/O B/L UPPER AND LOWER LIMBS  SWELLING INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE PITTING TYPE, AGGRAVATED ON WALKING; RELIEVED ON LOWER LIMB ELEVATION.. C/O DYSPHAGIA TO BOTH SOLIDS AND LIQUIDS SINCE 1 DAY. NO C/O FEVER, COUGH, COLD, SOB NO C/O ORTHOPNEA, PALPITATIONS, PND NO CIO BURNING MICTURITION, INCREASED OR DECREASED URINE OUTPUT NO C/O LOOSE STOOLS, NAUSEA, VOMITINGS, CONSTIPATION PAST HISTORY: K/C/O HTN SINCE 15 YEARS, STOPPED MEDICATION SINCE 15 DAYS K/C/O CKD SINCE 15 YEARS K/C/O CVA SINCE 2MONTHS,  RIGHT HEMIPARESIS  K/C/O FLUOROSIS OF SPINE SINCE 13YEARS H/O RIGHT LOWER LIMB FRACTURE SURGERY(TIBIAL PLATING ) PERSONAL HISTORY: MIXED DIET APPETITE NORMAL BOWEL MOVEMENTS NORMAL BLADDER: NORMAL NO ALLERGIES NO AD...
Read more