70/M paddy farmer with pedal edema upto thighs

A 70 year old Paddy farmer, came to OPD with c/o B/L pedal edema and shortness of breath since 6 months

Pt was apparently asymptomatic 6 months back, then developed B/L pitting type of pedal edema upto thighs, facial puffiness, anasarca. Then he went to a private hospital in Hyderabad, during routine investigations was told to have elevated creatine levels and was told to undergo dialysis

Pt then came to KIMS, NKP for further management. 

Pt has lost his livelihood since the last 6 months because he's been unable to work. He's survived by his wife and his son who lives elsewhere. He also has two daughters but they don't live with him.

C/o B/L hip pain since 6 months 

No c/o decreased output of urine

No h/o Fever, cough, cold

In KIMS, KNO, pt underwent 10 sessions of dialysis

1st-8/12

2nd-11/12

3rd-15/12

4th-22/12

5th-27/12

6th-31/12

7th-8/1

8th-17/1

9th-22/1

10th-26/1

Patient is a k/c/o Hypertension and DM since 20 years, on regular medication.

Started on insulin 4months back, twice a day, 10-20 units of insulin

Not a k/c/o TB, Asthma, Epilepsy 

Operated for inguinal hernia 4 years back

H/o Burn 6 years back

Vitals:

Temp- 98.6F

BP- 140/80 mmhg

PR- 86 bpm

RR- 17 cpm

Spo2- 99% at RA

General Examination:

Patient is conscious/coherent/cooperative 

Moderately built and well nourished

Pallor +

Icterus -

Cyanosis -

Koilonychia -

Lymphadenopathy-

Pedal edema + upto ankle 

CVS- S1 S2 + No murmurs 

RS- BAE+ No added sounds 

P/A- Soft, Non tender 

CNS- NAD

FLUID AND SALT RESTRICTION

T. LASIX 40MG PO/BD

T. NICARDIA 10MG PO/BD

T. OROFER XT PO/OD

T. NODOSIS 500MG PO/OD

T. SHELCAL CT PO/OD