Long case
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A 50 year old female is presented to OPD with chief complaints of shortness of breath and bipedal edema since 8 months.
HISTORY OF PRESENT ILLNESS-:
Patient was apparently asymptomatic 3 years back then she developed severe headache and went to nearest hospital and was diagnosed with hypertension.
Patient developed shortness of breath 8 months back which aggrevated in supine position and also complain of pedal edema which is pitting in nature and gradually progressed then patient went to KIMS and was diagnosed with chronic kidney disease and she was on maintenance hemodialysis.
She underwent two dialysis session in a week.
Since 1 month, Patient complaints of high grade fever which is intermittent in nature and subsides on medication and productive cough.
Yesterday Patient had 3-4 episodes of vomiting in a day after hemodialysis.
HISTORY OF PAST ILLNESS-:
Patient is hypertensive since 6 years
No history of diabetes, tuberculosis, CAD,epilepsy
PERSONAL HISTORY-:
Diet-mixed
Appetite-lost
Bowel and bladder movement-constipation
Micrurition-normal
Sleep-inadequate
No addictions
FAMILY HISTORY-:
No member in the family has similar complaints.
TREATMENT HISTORY-:
Patient has no history of surgical procedure.
Patient has no history of drug allergy.
GENERAL EXAMINATION-:
Patient is conscious,coherent and cooperative.
There is sign of pallor
There is sign of bipedal edema which is pitting in nature.
There is no sign of icterus, cyanosis, clubbing, generalised lymphadenopathy.
Vitals-:
Temp :Afebrile
Pulse rate:90bpm
Respiratory rate:16cpm
Bp:140/90 mm/hg
Spo2-98%
SYSTEMIC EXAMINATION:
CVS examination
Inspection-:
No precordial bulge
No scar, sinuses and engorged vein
No visible pulsation
Palpation-:
Apical impulse- heard in 5th intercoastal space
Auscultation-:
S1 and S2 heard
No murmurs
CNS examination
Higher mental function-Normal
Cranial nerves-intact
Sensory system-normal
Motor system-normal
Meningeal signs- absent
Cerebellar signs-absent
RESPIRATORY SYSTEM :
Inspection of upper respiratory system-:
Oral cavity-normal
Nose-normal
Pharynx-normal
Inspection of lower respirator tract-:
Trachea- central
Symmetry of chest-symmetrical
Movement- bilateral symmetrical expansion of chest respiration
No scar,sinuses and engorged vein
Palpation:
All inspectory findings are confirmed by palpation.
Trachea: central - confirmed by three finger test.
Assessment of anterior and posterior chest expansion- B/L symmetrical expansion of chest.
No chest wall tenderness
Percussion :
It is done in sitting position
Resonant
Auscultation:
Vesicular breath sounds heard
ABDOMEN:
Shape of abdomen-scaphoid
No tenderness
Provisional diagnosis
Chronic kidney disease
INVESTIGATION-
Treatment-:
Tab NODOSIS 500mg BD
Tab NICARDIA 10mg BD
Tab LASIX 40mg BD
Tab ARCAMINE 0.1mg TID
Tab SHELCAL 500mg BD
Tab OROFERXT OD
Tab PAN 40mg OD
Inj Erythropoietin 4000 IV/SC weekly once
Inj IRON SUCROSE 1AMP in 100ml NS during dialysis
FLUID RESTRICTION<1l per day
SALT RESTRICTION<2.4g/day
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