A 55 YR OLD FEMALE WITH CRF.

A 55 yr old female Pt. Came to the casualty with the c/o SOB since 2 days and decreased urine output.
c/o  B/L pedal edema since 2 days .
Pt. was apparently asymptomatic 6 yrs back and then developed B/L pedal edema for which the patient visited the nearby hospital and was diagnosed with HTN and RENAL FAILURE.Since then the patient was in conservative management.
But since two days patient is having SOB 
(grade 4) not associated with chest pain, sweating , nausea , vomitings.
H/O B/L pedal edema pitting type.
H/O decreased urine output with increased frequency and has urinary hesistancy ,no h/o  burning micturition , no h/o urgency.
K/C/O HTN since 6 yrs
Not a K/C/O DM, Asthma , Tb, CAD, Epilepsy.
O/E
CVS - S1 S2 + 
R/S - B/L diffused crepts present.
CNS - NAD
P/A - soft and non tender.
Vitals - 
Bp - 160 /80 mmHg 
Hr - 106 bpm
Rr- 30 cpm
Spo2 - 92 % at RA.

DIAGNOSIS - CHRONIC RENAL FAILURE.

MANAGEMENT -
1.INJ. LASIXLASIX 40 MG IV/BD
2.TAB. NODOSIS 500 MG PO/OD
3.TAB.MET XL 25 MG PO/OD
4.TAB.AMLONG 10 MG PO/OD
5.CAP.BIO D3 PO/WEEKLY ONCE
6.TAB.SHELCAL 50 MG PO/OD
7.TAB.OROFER XT PO/OD
8.INJ.ERYTHROPOEITIN 5000U /SC/WEEKLY ONCE.

Comments

Post a Comment

Popular posts from this blog

A 45 YR OLD MALE WITH INVOLUNTARY MOVEMENTS OF UL AND LL

Image
A 45 old male who was has been having a diabetic foot (necrotising fascitis on the plantar aspect of left foot)since 3 months since then he has been undergoing debridement procedure and then and had SSG 10 days ago.He was a diabetic patient since 10 yrs. He is a farmer by occupation. He had h/o toe amputation 3 yrs ago. The patient had seizure like activity yesterday night ( tonic clonic type) with loc. GCS - 6/15 O/E  Pt is drowsy but responding to commands Bp - 110/70 mmHg Pr - 84 /min CVS - s1 s2 + R/S - BAE+ P/A- soft , non tender  CNS - E 4 V 2 M 4 Both UL and both LL tone normal  Power - Moving upper limbs and rt. Lower limb. Reflexs- B ++ T ++ S ++ K ++ A ++ Pupils -Rt - reactive to light, Lt - mild dilated unresponsive. Diagnosis - SEIZURE LIKE ACTIVITY DUE TO HYPONATREMIA. ?SIADH ?ATN ?Chronic hyperglycemia.
Read more

A 55yr old male with Anterior wall MI.

Image
A 55 yr old male pt. came to the casualty with c/o chest pain , sob ( grade 3),nausea,loss of appetite and b/l pedal edema since 3 days.Reduced urine output since 1 day. Pt was apparently asymptomatic 3 days ago then he developed sob (grade 3) ,not associated with cough ,no h/o fever, no h/o orthopnea and no h/o PND , h/o B/L pitting edema , K/c/o pulmonary kochs (used ATT for 9 months 4 yrs back) K/c/o DM2  since 1 yr and is on GLIMY M1/ PO  O/E  Pt is c/c CVS - s1 s2 + R/S - BAE + , inspiratory crepts + in Rt MA IMA IAA , Rt. Sided wheeze + P/A soft and non tender CNS - E4V5M6 Vitals- Pr- 107bpm  Bp- 80/60  Spo2 - 93 % at RA. DIAGNOSIS - Anterior wall MI with pneumonia (REACTIVATION OF PULMONARY KOCH'S ) TREATMENT - INJ. Lasix 40 mg iv stat Inj. Noradrenaline 2ml in 45ml ns @ 8ml
Read more

A 45 YR OLD ALCOHOL-DEPENDENT PATIENT.

Image
A 45 yr old male patient who was a constable by occupation (but he left the job one and half yr ago because of his chronic alcoholism, Irregular schedules and disturbed mind ) came to the opd on his own intention of quiting the habits of drinking alcohol and chewing tobacco, by getting admitted in the de-addiction centre here. He has grade -2 SOB. He has cough  associated with sputum since 10 days  HOPI-Patient started consuming alcohol 22 yrs ago, back then he used to consume alcohol only occasionally and of a quantity of around 3 units of alcohol (once a week) and occasional chewing of tobaco.Then he along with his childhood friends started increasing the frequency of consuming alcohol from past 15 yrs and got habituated to consume alcohol daily from past 10 yrs(25 units/day) and regularly chew tobacco (10 packets/day). Then as this routine is going on,he had conflicts with his wife 8 yrs ago and so they started living seperately (daughter staying with her mom).Since then he got addi
Read more