1701006105 CASE PRESENTATION
A 22 year old female daily wage worker by occupation resident of miryalaguda came to OPD with the chief complaints of
# Generalized edema since 6 days
#decreased urine output since 6 days
HOPI:
she was apparently asymptomatic 6 days back then she developed generalised edema ,which is insidious in onset, initially started in the face and then extended to involve whole of the body .oedema is of pitting type ,no aggravating and relieving factors.
Decreased urine output since 6 days.
No h/o burning micturition
No h/o hematuria
No h/o cough and fever
No h/o abdominal pain
No h/o chronic cough and weight loss
No h/o headache and blurring of vision
PAST HISTORY;
H/o similar complaints 15 days back
K/c/o DM TYPE 1 SINCE 12 YEARS and on medication (isophane insulin)
K/C/O HTN since 1 year on medication Telma 40 mg and nicardipine 20 mg
NO H/O TB,ASTHMA,CAD, EPILEPSY
PERSONAL HISTORY;
DIET:MIXED DIET
APPETITE: DECREASED
BOWEL AND BLADDER: BOWEL IS REGULAR BUT THERE IS DECREASED URINE OUTPUT SINCE 6 DAYS
SLEEP -ADEQUATE
FAMILY HISTORY;
NO H/O DM,HTN,TB, ASTHMA IN the family
GENERAL EXAMINATION;
AFTER TAKING CONSENT and after adequate exposure,she is examined in a well lit room .
She is conscious, coherent and cooperative
She is oriented to time ,place and person.
On examination there is pallor.
No icterus, clubbing, cyanosis lymphadenopathy.
Generalised edema is present(pitting type)
VITALS:
TEMPERATURE - FEBRILE(99.5)
PULSE RATE-90 BPM
RR-23 CPM
BP-140/90mmhg measured in supine position in left upper arm
Spo2- 96%at room air
Grbs; 203mg/dl
SYSTEMIC EXAMINATION;
PER ABDOMEN;
INSPECTION;
shape of ABDOMEN ; round and distended
Umbilicus - inverted and central in position
No visible scars and sinuses
No engorged veins
PALPATION;
Inspectory findings are confirmed
Soft and non tender
No organomegaly
Fluid thrill is present
PERCUSSION;
DULL NOTE HEARD
AUSCULTATION;
Normal bowel sounds heard
No bruit heard
RS :
On inspection B/L SYMMETRICAL CHEST
on palpation,decreased movement of chest on both lower lobes(infrascapular and infra axillary areas)
On percussion there is Stony dullness over both lower lobes
On AUSCULTATION,there is absent breath sounds over both lower lobes
CNS; intact , NAD
CVS; S1,S2 heard ,no murmurs
PROVISIONAL DIAGNOSIS:
CHRONIC KIDNEY DISEASE ON MAINTAINANCE HAEMODIALYSIS
INVESTIGATIONS;
CBP;
Hb-6.5g%
RBC COUNT:2.42million/cumm
TC -7100cells/cumm
PCV:19.4%
MCV:80.2fl
MCH:26.9
RDW-SD:41.9
Blood urea;110 mg/dl ;on 10/06/22 and on 11/06/22 -127mg/dl
Serum creatinine; 6.2 mg/dl
Serum electrolytes;
Na-136 mEq/l
K-3.5mEq/l
Cl-97 mEq/l
SEROLOGY;
HbsAg-negative
Anti Hcv antibodies -non reactive
HIV 1/2 rapid test -non reactive
USG;
IMPRESSION;
B/L grade 2 RPD
GROSS ASCITES
B/L MODERATE TO GROSS PLEURAL EFFUSION
Chest XRay;
TREATMENT;on 10/06/22
INJ.LASIX 60 mg/iv/BD
Inj.Human act rapid insulin 6U/iv /stat
Insulin infusion 6ml/hr (1 ml of insulin in 39 ml NS)
Tab.nicardia 20 mg / po/oD
Tab.telma 40 mg /PO/OD
NBM till further orders
Fluid and salt restriction
Grbs monitoring hourly
Treatment on 11/06/22
Inj.LASIX 60 mg /iv/BD
Insulin infusion 6ml /hr (1 ml of insulin in 39 ml NS)
Tab.nicardia 20 mg /po/BD
Tab.TELMA 40 mg /po/oD
NBM till further orders
Fluid and salt restriction
Grbs monitoring hourly
Hemodialysis done 10 days back .5 times .
A 52 yr old male , resident of Nalgonda,farmer by occupation,came to the opd on 7/06/22 with chief complaints of
# fever since 4 days #abdominal distension since 3 days
HISTORY OF PRESENT ILLNESS;
He was apparently asymptomatic 4 days back then he developed fever which was insidious in onset low grade type , continuous,relieved on medication,not associated with chills and rigors.associated with loss of appetite
Abdominal distension -insidious in onset, gradually progressive and not associated with any pain .
No h/o headache, vomiting,loose stools.
No h/o rash,cough and hemoptysis
No h/o body pains
No h/o weight loss
PAST HISTORY;
NO similar complaints in the past.
Not a known case of HTN, TB, ASTHMA,DM,CAD, EPILEPSY.
PERSONAL HISTORY;
DIET; mixed
Appetite: decreased since 3 days
Bowel and bladder; regular
Sleep : adequate
He takes alcohol (90 ml ) and toddy(1 bottle) occasionally.
No known drug allergies.
FAMILY HISTORY;
No similar complaints in the family
GENERAL EXAMINATION;
after taking consent from patient,he examined in a well lit room after adequate exposure.
He is conscious, coherent, cooperative,well oriented to time ,place and person.
There is pallor .
No icterus, clubbing, cyanosis, lymphadenopathy,edema.
VITALS :
Temperature; now Afebrile but @time of admission he is febrile.
PULSE:85 BPM
RR;20 cpm
Bp;120/80 mmHg measured in supine position,in left upper arm .
Spo2:98%at room air
Grbs;120 mg/dl
SYSTEMIC EXAMINATION;
PER ABDOMEN;
INSPECTION:
Shape of ABDOMEN; round and distended
Umbilicus; inverted and central in position
No visible scars and sinuses
No engorged veins .
PALPATION;
Inspectory findings are confirmed.
Soft and non tender ,no organomegaly , abdomen is distended .
PERCUSSION; dullness on percussion
AUSCULTATION;
Bowel sounds were heard
No bruit.
RS;
BAE- PRESENT
NO ADDED sounds
CVS;
S1,S2 heard ,no murmurs
CNS:intact,NAD
PROVISIONAL DIAGNOSIS;
VIRAL PYREXIA WITH THROMBOCYTOPENIA.
INVESTIGATIONS;
CBP;
Hb;14.9g%
TC;10,500
Platelets;17000/cumm @outside hospital report
On 8/06/22: 22000 /cumm
Neutrophils -43
Lymphocytes -48
Eoisinophils -01
Blood urea-59
Serum creatinine -1.6mg/dl
Serum electrolytes:
Na-142 mEq/l
K-3.9mEq/l
Cl-103 mEq/l
LFT:
TB-1.27
DB;0.44
SGOT-60
SGPT-47
ALP-127
TP- 5.9
Albumin-3.5g/dl
A/G ratio-1.48
CUE:
Albumin -positive
Pus cells -4-5
Epithelial cells -2-3
NS1 ANTIGEN - POSITIVE
SEROLOGY -IgM and IgG negative
Investigations on 9/06/22;
Hb- 14.3g%
Platelets- 30,000/cumm
On 10/06/22,
Hb-14.0 g%
Platelets; 84000/cumm
USG;
IMPRESSION;
GRADE 2 FATTY LIVER
MILD SPLENOMEGALY
RIGHT SIDE PLEURAL EFFUSION (MILD)
MILD ASCITES
Treatment;
*On 8/6/22;
IV FLUIDS - NS AND RL@100ML/hr
Inj.pan 40 mg iv /oD
Inj.optineuron 1 amp in 100 ml Na iv/OD over 30 mins
Inj.zofer 4 mg iv/SOS
VITALS monitoring 4th hourly
*On 9/6/22
Iv fluids - Ns/RL @100 ml/hr
Inj.pan 40 mg iv/OD
Inj.optineuron 1 amp in 100 ml/Ns/iv/OD over 30 mins
Inj.zofer 4mg/iv/sos
Tab.doxycycline 100mg PO/BD
VITALS monitoring
I/o charting.
*On 10/06/22;
Iv fluids -DNS ,NS,RL@100 ml/hr
Inj.pan 40 mg iv/oD
Tab.doxycycline 100 mg Po/BD
Inj zofer 1 amp iv/sos
Inj.optineuron 1 amp in 100 ml Ns/iv/OD over 30 mins
VITALS monitoring 4 th hourly
I/O charting.
*On 11/06/22;
Iv fluids -DNS ,NS,RL@100 ml/hr
Inj.pan 40 mg iv/oD
Tab.doxycycline 100 mg Po/BD
Inj zofer 1 amp iv/sos
Inj.optineuron 1 amp in 100 ml Ns/iv/OD over 30 mins
VITALS monitoring 4 th hourly
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