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55 year old man with pedal edema

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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
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65/M Farmer/Ration shop owner

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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
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45/F cook by occupation

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 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
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70/M paddy farmer with pedal edema upto thighs

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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
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57/M with HTN since 4 months

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 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. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box A 57 year old male patient with bilateral pedal edema 57 year old male farmer by occupation Came with complaints of fever since 3 days Patient was apparently asymptomatic 4 months back then he developed:  Bilateral pedal edema, pitting type, insidious in onset, gradually progressive from ankle to below knee H/o dcreased urine output No h/o palpitations or burning micturition or chest pain. C/o B/L knee pain since 4 months Patient went to the outside hospital were renal function test
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29/M with fever and lower backache since 2 days

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29 year old male came to casualty with complaints of fever and lower backache since 2 days. Fever low grade, a/w chills and rigors, subsided on medication. Pain was dragging type, in lower back radiating to front. Pt was apparently asymptomatic 1 year back, then presented to casualty with similar complaints along with decreased urine output hicupps and vomiting from 2 days, then developed involuntary movements of right lower limb for which he visited local hospital and on routine investigations was found to be hypokalemic, took some medication and the situation resolved. 6 months later he developed lower backache and investigations revealed renal calculi for which conservative management was done and complaints got resolved. then pt developed right sided involuntary movements again, went to local RMP, had 2 episodes of GTCS and referred to KIMS, NKP for further evaluation. Was diagnosed as ACUTE KIDNEY INJURY/NCC/TUBERCULOMA (2° seizures) and (in March of 2021) pt underwear 4 session
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55/F with sweating and low sugars

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55 year old house wife came to casualty with complaints of: Sweating and seizure like activity since 1½ hr, after insulin injection Pt was apparently asymptomatic 10 years back then on routine checkup was told to have Diabetes Mellitus type 2 and advised to use Inj. Human Mixtard 15 units, twice a day. Dosage increased to 20 units one month back. Pt had C/O polyuria, polydypsia and loose stools 1 month back. stools were watery consistency, non blood stained, 10 episodes per day for 3 days. Watery stools subsided on medication. Last night pt consumed her meal, followed by s/c insulin injection. ½ hr later pt developed profuse sweating, cold to touch, clenching of fists, uprolling of eyes, frothing at mouth and loss of consciousness.  Seizure like activity lasted ½ hr Post ictal confusion (+) Non responsive to verbal commands or touch stimulus No H/O fever, burning micturition, cold Pt was administered 2 IVF- 25 D, after that pt regained consciousness and no seizure episodes after that. 
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