57 year old male came to opd with generalised edema, decreased urine output from past one month, chest pain from 4days.

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A 57 yr old male patient resident of gopalayapalli came to opd with chief complaints of generalised edema and decreased urine output since one month, chest pain since 4 days.

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic one month back later he developed swelling of face followed by abdomen and limbs which is pitting type since one month.

 He had decreased urine output since one month.Intially there was dribbling of urine later there was complete stoppage of urine.

He had chest pain since 4 days which was sudden in onset, dragging type,radiating towards back,and aggravated at night.

H/o fever associated with chills,on and off type since one month.

H/o shortness of breath (grade 3)

H/O cough associated with sputum since one month and not relieved on medication.

It is not associated with chest pain and no diurnal variation.

Sputum is blood tinged.

He had 9 sessions of dialysis (on alternate days) from one month recent one was yesterday.(23/11/22)

PAST HISTORY:

He is diabetic since 15 yrs.He is using gluconorm and since one month he is on insulin.(because of his flucutating blood glucose levels)

He had Hypertension since 5 yrs and he is under medication.

No H/o epilepsy,CAD,Asthma.

No H/o surgeries in  past.

No allergic history.

FAMILY HISTORY:

His mother and father are hypertensive.

PERSONAL HISTORY:

Diet:Mixed 

Appetite:Normal

Sleep: Adequate

Bowel and bladder movements: Decreased urine output and had constipation.

Addictions: Alcoholic since 15 yrs stopped one month back 

Smoker since 30 yrs and stopped 20 yrs back.

GENERAL EXAMINATION:

Patient is conscious, coherent and cooperative.

Moderately built and nourished.

No signs of icterus,cyanosis, clubbing, lymphadenopathy.

He had generalised edema( pitting type),pallor.

 Vitals:

PULSE:92bpm,regular,normal volume,no radio radial delay,no radio femoral delay.

BLOOD PRESSURE:130/80mm Hg,in sitting position, in the right arm.

RESPIRATORY RATE:22cpm

TEMPERATURE: afebrile

GRBS:218mg/dl

SYSTEMIC EXAMINATION:

Respiratory system:

Bilateral air entry-present ,

Normal vesicular breath sounds-heard.

Cardiovascular system:

S1 and S2 heard no murmurs heard 

Central nervous system: 

No focal neurological deficit.

Patient is concious coherent.

Higher mental status-

Cranial nerves- intact

Motor system:

  Tone- normal 

 Power- normal

Cerebellar functions-normal 

Abdominal examination: 

soft and non tender, 

No Hepatomegaly, spleen is not palpable.

INVESTIGATION:

Urea-187mg/dl

Creatinine -9.4mg/dl

Phosphorus-5.5 mg/dl

CBNAAT:

Rifampicin resistant TB

PROVISIONAL DIAGNOSIS:

CLD ON MHD

TB

Treatment:

T.Nicardia20 mg po bd

T.Nodosis 500mg po bd

T.lasix 80mg po bd

T.Orofer po od

T.shellcal po od

T.met xl 25 mg po od

Inj.HAI s/c according to grbs

Inj.Erythropoietin 400 U s/c weekly once

Collincoff  5ml po tid

Monitor vitals 4th hrly

Grbs monitoring 6th hrly

Syp.Sucral 10ml tid

Inj.Tranexa 500 mg iv/bd

Inj. pantop 40mg iv/bd