A 73 YEAR OLD MALE PATIENT WITH PEDAL EDEMA, SHORTNESS OF BREATH AND DECREASED URINE OUTPUT
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MAY 15,2021
CASE DISCUSSION
A 73 yr male patient teacher by occupation, resident of .............. presented to Opd with chief complaints of :
- PEDAL EDEMA ,SINCE 15 DAYS
- SHORTNESS OF BREATH, SINCE 4 DAYS
- DECREASED URINE OUTPUT ,SINCE 2 DAYS
HISTORY OF ILLNESS
Patient is chronic alcoholic since 40yrs ( stopped few months back) and non-smoker was apparently asymptomatic 30yrs ago. He was diagnosed with type 2 diabetes mellitus 30yrs back and hypertension 19yrs back on regular checkup. Since then he has been on medication with Tab.Glicazid 80mg BD and since 4 yrs he has been taking human mixtard insulin 15u-0-8u daily for DM and on Tab. Telma H 40/12.5gm, Tab.Prazosin 5mg BD and Tab.Met-xl 50mg BD .
Pedal edema since 4 years associated with exertional dyspnea . On checkup was diagnosed with CKD STAGE 4. Was started on medication with Tab.Dytor 10mg and Tab.Nodosis 500mg BD . He used the medication for 3yrs following which his creatinine levels dropped from 3mg to 2mg . He stopped the medication as his creatinine levels reduced since a year following which he complaints of ON AND OFF pedal edema which has increased significantly since past 15 days.
Blurring of vision , since 4yr ( Diabetic retinopathy).
H/O fever and cough 3 months back .He was tested covid-19 positive and was on medication and in home isolation . He was tested negative after 10 days of illness.
2 months ago , pt. complaints of spontaneous formation of bleb on 3rd toe of left lower limb. Dressing done by local RMP.
1 month ago ,H/O unresponsiveness and starring look - 1 episode of hypoglycemia. h pt. regained consciousness after administration of iv fluids. attenders claim it to be due to his blurred vision he must have taken high dose of insulin than prescribed dose.
H/O RTA 10 days back causing injury to left lower limb -laceration wound present .dressing done by local RMP, using analgesics.
SOB since 4 days which progressed from grade 2 to grade 3 associated with orthopnea and PNS, unable to sleep due to sob since 4 days.
decreased urine output since 2days.
No H/O fever , cold , cough, facial puffiness .
PERSONAL HISTORY
GENERAL EXAMINATION
ULCER ON LEFT LOWER LIMB
SYSTEMIC EXAMINATION:
INVESTIGATIONS
ECG ON DAY 2 :
atrial fibrillation on day 2 .injection amiodarone was started.
DAY 3: pt. went LAMA as they can avail ESH in other hospital.
DIAGNOSIS
TREATMENT
salt restriction diet (<2g per day)
Inj. Lasix Infusion 2amp(80mg)+46ml NS @2ml/hr ( 3.2mg/hr)
Tab. Met-xl 50mg PO BD
Tab. Orofex-xt PO OD
Tab.Ecospirin-AV (75/20) night single dose
Protein x powder 2 scoops in glass of milk BD
Tab. Prazosin 5mg PO BD
Tab. Teneligliptin 20mg PO OD
Inj. Human mixtard insulin S.C after informing 8am-2pm-8pm
GRBS 6th hourly ( 8am-2pm-8pm-2am)
Daily dressing for ulcer
Inj. Augmentin 1.2g IV BD
BP /PR monitoring 2nd hrly
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