Pranati V (roll no. 129)

55 year old man with c/o decreased urine output, pedal edema,sob since 1year. Patient was apparently asymptomatic 1year back then he developed bilateral pedal oedema (pitting type). Gradually progressive a/w sob and h/o decreased urine output.no h/o palpitation,burning micturition. K/c/o HTN ON tablet Nocardia 10mg N/k/c/o DM,TB,ASTHAMA, EPILEPSY,CAD. ON EXAMINATION_PATIENT IS CONSCIOUS,COHERENT , COOPERATIVE. TEMP-AFEBRILE. PR-83BPM BP-120/80MMHG RR-17CPM SPO2-98 GRBS-121MG/DL CVS-S1S2+ RS-BAE+,NVBS. CNS-NAD INVESTIGATIONS- ON 22/12/2021 BLOOD UREA-79MG/DL SERUM CREATININE-7.4MG/DL SODIUM-148MEQ/L POTASSIUM-3.9MEq/L CHLORIDE-98mEq/L SERUM IRON- 94ug/dl HBsAg-negative HIV-NON REACTIVE HCV-NEGATIVE BLOOD GROUP-O POSITIVE Rx- FLUID AND SALT RESTRICTION T. LASIX 40MG PO/BD T. NICARDIA 10MG PO/BD INJ. ERYTHROPOIETIN 4000IU IV/SC WEEKLY ONCE Ward D 55/M  S- c/o decreased appetite since yesterday O-  C/c/c Bp- 130/80mmHh PR-92bpm RR- 16cpm CVS- S1 S2 heard RS- BAE (+V

65/M  FARMER BY OCCUPATION   Pt WAS APPARENTLY NORMAL 16 YEARS AGO, WHILE WORKING IN THE FIELDS, A THORN PRICKED HIS LEFT LEG AND FORMED A NON HEALING ULCER, WENT TO A PRIVATE HOSPITAL AND WAS FOUND TO BE DIABETIC, STARTED ON OHA (UNSURE OF THE MEDICATION), AND CONTINUED TO USE MEDICATION IN LATE 2019, ANOTHER INJURY OCCURRED TO THE LEFT FOOT, FORMED ANOTHER ULCER, RESULTING IN GRADUAL BLACKENING OF THE TOES. DIAGNOSED AS DIABETIC FOOT. AMPUTATION OF THE FIRST TWO GOES OF LEFT FOOT DONE. PATIENT HAS BEEN USING A CANE FOR SUPPORT TO WALK SINCE THEN. IN DECEMBER 2020, H/O SOB GRADE 2 SINCE 4 MONTHS WHICH PROGRESSED TO GRADE 3 2 MONTHS AGO AND DIAGNOSED AS ADHF AND CAG WAS DONE. ON REGULAR MEDICATION (SEPTEMBER, 2021)FIVE MONTHS AGO HE HAD C/O SWELLING OF ARMS AND LEGS (UPTO THIGHS) ,FACIAL PUFFINESS,NAUSEA VOMITING,CONSTIPATION AND ABDOMINAL DISCOMFORT FOR WHICH HE WENT TO A HOSPITAL IN KHAMMAM WHERE INVESTIGATIONS WERE DONE HE WAS ADVICED ADMISSION BUT HE DENIED AND WENT TO NIMS,HYD ON

 45 year old with pedal edema  A 45 year old female, cook by occupation, mother of two, came to the OPD on 21/1/22 with chief complaints of loss of appetite and  vomiting since 2 months  Pedal edema since 1 year No c/o Shortness of breath, decreased urine output, burning micturition. The patient was apparently asymptomatic 1 year ago then she developed pedal edema, on and off,  upto mid calf level ,which relieved on walking.  C/o facial puffiness on and off since 1 year  The pt went to a hospital in Nalgonda for the same where her Sr.creat was 11.0 The pt was advised for dialysis I/v/o high serum creatinine but they were not willing to get it done and so was started on medication after which her serum creatinine came down to 7.  The pt has been using the same medication since the past one year with which she was comfortable  as her complaints subsided and was leading a normal life. Since 2 months  ago she developed loss of appetite and vomiting for which she went to a priv

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 ba