72Y Male with SOB and fever since 7 days
Patient came with C/o fever since 2 days
C/o breathlessness since yesterday
HOPI :- patient was apparently asymptomatic 2 days back then he developed fever which is insidious in onset ,gradually progressive, continuous low grade with chills and rigors relieved with medication.
Breathlessness since yesterday insidious in onset gradually progressive present even at rest , NYHA GRADE IV ,not relieved with rest , associated with cough with expectoration which is white in colour.
No h/o pedal edema , abdominal distension.
H/o decreased urine output and burning micturition.
Past history:- Not a k/c/o DM,HTN,BRONCHIAL ASTHMA , THYROID AND SEIZURE DISORDERS
K/c/o TB 8 years back used medication.
General examination:- pt is C/C/C.
Pallor + , no cyanosis, icterus, clubbing, lymphadenopathy, edema.
Temp - 100.8F
Bp - 100/60mmhg
Pr- 104 bpm
Spo2 - 75 at RA at admission
Addictions :- alcoholic and tobacco chewer since 40 years.
Systemic examination:-
CVS - S1S2 heared, No murmurs.
RS - NVBS
CNS - NFND
P/A - soft ,non tender
Pursed lip breathing video
PROVISIONAL DIAGNOSIS:- Heart failure with preserved Ejection fraction.
FINAL DIAGNOSIS :- Heart failure with preserved Ejection fraction EF - 52%
AKI on CKD secondary to right mild hydro ureteronephrosis
Pyrexia secondary to ?cystitis
H/o TB 8 years ago
Chest xray:-
Ultrasound done on 31/12/23
>right mild hydro utero nephrosis
> bilateral grade I RPD changes
> GB wall edema
> thickness of urinary bladder wall and internal edoes
Review usg done I/v/o RPD changes, free fluid in abdomen, prostate size.
Review USG
Right kidney = 9 × 3.4cm,
Left kidney = 9 × 3.2 cm
Ms|Te, CMD = Partially lost
Mild hydrophrosis
Ureters = obscured.
-> No ascitics
-> urinary bladder = empty, foley's in situ.
Urology refferal was done on 3/1/24 I/v/o
Right hydro ureteronephrosis and flank pain
On examination:-
On DRE - Grade I prostate
Advised
Tab. Tamsulosin 0.4 mg PO H/S
Syp. Citralka 15 ml in half glass of water po bd
Tab Nodosis 500 mg po bd
Cap. Bio d3 po od
Blood Culture & sensitivity report : No Growth after 24hrs of aerobic incubation.
URINE CULTURE REPORT:-
NCCT KUB VIDEO :-
COURSE IN THE HOSPITAL :-
A 70 y old male came with complaints of fever since 2 days and breathlessness since yesterday and diagnosed as Heart failure with preserved Ejection fraction EF - 52%
AKI on CKD secondary to right mild hydro ureteronephrosis
Pyrexia secondary to ?cystitis
H/o TB 8 years ago.
Due to severe pain abdomen NCCT KUB was done and showed
1)Right side Emphysematous pyelonephritis type 2
2)obstructing calculus in upper ureter.
But patient went into septic shock so was started on NORAD INJ at 4ml /hr .
Bp was maintaining.. inj meropenam was given after 2 days bp was maintaing without ionotropic support and DJ stenting was done.
Abdominal pain subsided.
Treatment:
Fluid restriction less than 1.5L/day
Salt restriction less than 2g/day
Inj.MONOCEF 1G IV/BD
Inj.CIPROFLOXCIN 200mg IV/BD
Inj.PAN 40mg IV/BD
Inj.BUSCOPAN 1amp IV/BD
Inj.TRAMADOL 1amp in 100ml NS IV/BD
TAB.MET XL 25mg PO/OD
TAB.ECOSPIRIN AV 75/10 PO/HS
TAB.PULMOCLEAR PO/BD
TAB.MONTEK LC PO/HS
NEB with BUDECORT 12th hourly, IPRAVENT 6th hourly
Strict I/O CHARTING
MONITOR VITALS
GRBS 7th profile
INJ. H. ACTRAPID with 10U INSULIN within 1hour
NEB with SALBUTAMOL 4th hourly
INJ.ZOFER 4mg IV/TID
SYP.ARBOSZYSME 10 ml TID.
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