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A 40 year old male resident of Nalgonda came with the complaints of Shortness of breath,facial swelling,pedal edema.
Chief complaints:
Bilateral lower limb swelling since 20 days.
Generalized anasarca since 15days .
Shortness of breath grade 3 and 4 since 10days.
History of present illness:
The patient was apparently asymptomatic 4 months back .He used to go for work (farming) before 4 months .Suddenly he developed cough along with Shortness of breath ,for which he was taken to private hospital in Nalgonda where he was diagnosed with kidney failure and was advised to undergo dialysis.
He Underwent 6 sessions of dialysis for a period of 9 days ,and SOB was relieved with dialysis.
After that he came to OPD where he is diagnosed with CKD and advised for dialysis later he developed pedal oedema after 20 days of the first visit ,the edema is of pitting from below knees ,the edema subsides for 2 days after the dialysis session and patient develops edema later until the next session .
He also had history of fever, headache.one episode of seizures 3 months back.
No h/o vomiting.
He complaints of bilateral lower limb swelling since 20 days and generalised anasarca since 15 days and shortness of breath (grade 3) since 10days. He also complaints of cough with sputum.
Past history:
The patient is a known case of HTN since 3 years and is on medication.
No h/o DM,BA, CAD, TB .
Personal history:
Appetite - normal
Mixed diet
Bowel movements- regular
Decreased urine output
Takes alcohol occasionally.
Family history:No relevant family history .
Physical examination:
General examination:
patient is conscious, coherent and cooperative. Thin built and well nourished.
Pallor - present.
No icterus, no cyanosis,no clubbing, no lymphadenopathy
Oedema of feet: present
Vitals:
Temp- Afebrile
Pulse rate- on admission 120 beats/min
Resp rate - on admission 36 cycles/min
BP: 130/90 mmHg
Spo2 : 78% at RA
Systemic examination:
CVS: s1, s2 heard
RS: dyspnea present. BAE +
Abdomen: soft , non tender
CNS: No focal neurological deficit
Provisional diagnosis:
Pulmonary oedema secondary to acute left ventricle failure, anemia secondary to renal failure with HTN.
Investigations:
Treatment:
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