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




Popular posts from this blog

23/F P3L3 with multiple joint swellings

Image
LThis is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here, we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs 26 Year old, P3L3, last child birth 5 years back, a homemaker came to OPD with chief complaints of multiple joint pains, and backache since 3 years Pt was apparently asymptomatic 3 years back, then developed multiple joint pains, involving small and large joints (B/L DIP, PIP, MCP, wrist, elbow, knee, shoulder, ankle)  Low backache since 3 years  A/w ROM, swelling, low grade fever  Morning stiffness (+) for 10-15 min before resuming activity 20/2/21 RA- positive (February 2021) Used : T. METHOTREXATE 7.5MG PO/once weekly T. SULFAZALAZINE 500MG PO/OD T. OLFENAC-SR 200MG po/od T. METHYLPREDNISOLONE (?d
Read more

61 year old farmer (long distance)

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here, we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs 61 year old farmer by occupation came with chief complaints of chest tightness Pt was apparently asymptomatic 10 months back and had developed sudden onset dizziness and chest tightness. Whenever he consumes spicy or heavy foods, he experiences dragging type of pain in the left infra-axillary area of chest  When he applies pressure on left side of chest(infra axillary area for pain relief), there is relief, belching(+) Difficulty in passing stools, no blood or mucus in stools Right thigh- c/o sensation of insect crawling over thigh followed by burning sensation K/c/o HTN since 2 years, on T.Amlodipine
Read more

55 year old man with pedal edema

Image
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
Read more