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Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.
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Here is a case I have seen :
Unit 6 admission :
Case admitted in male ward on 6/2/2021.
Interns
B. Mani varma
K.Divya Rachana
K. Nikhil reddy
M. Swarna
Juveria
Dr. Vinay(pgy1)
Dr. Rashmitha(pgy2)
Dr. A. Vaishnavi (pgy2)
Dr. Sai Radha(pgy3)
Dr. Hareen (SR)
Dr.Praveen Naik( asst.proff)
50/M PRESENTED TO OPD WITH C/O
DYSPNEA ON EXERTION SINCE 1 MONTH
B/L PEDAL EDEMA SINCE 10 DAYS
FACIAL PUFFINESS SINCE 10 DAYS
PATIENT HAS BEEN EXPERIENCING DYSPNEA ON EXERTION SINCE A MONTH AFTER WALKING FOR SHORT DISTANCES. NOT ASSOCIATED WITH CHEST PAIN /ORTHOPNEA/PND/COUGH/REDUCED URINE OUTPUT
H/O B/L PEDAL EDEMA WHICH PROGRESSED TO HIS KNEES GRADUALLY OVER 10 DAYS HE 10 DAYS HE ALSO COMPLAINS OF FACIAL PUFFINESS SINCE 10 DAYS
HE C/O HEMATURIA/FROTHY URINE/ DECREASED URINE OUTPUT
HE TAKE ALCOHOL OCCASIONALLY SINCE 30 YEARS, LAST INTAKE WAS 4 YEARS BACK
DENOVO HTN
O/E - PATIENT IS CONSCIOUS COHERENT AND COOPERATIVE
PALLOR PRESENT, NO ICTERUS CYANOSIS CLUBBING LYMPHADENOPATHY
Bp 150/90mmHg
PR 84bpm
RR 22cpm
TEMP AFEBRILE
RESP SYSTEM :
BAE+ FINE CREPTS PRESENT IN IAA,ISA
CVS: S1S2 HEARD NO MURMURS
ABDOMINAL EXAMINATION :
SOFT AND NON TENDER
NO FREE FLUID, BRUITS,
NO HEPATOMEGALY, NO SPLEENOMEGALY
BOWEL SOUNDS PRESENT
INVESTIGATIONS :
LIPID PROFILE-
TOTAL CHOLESTEROL-126 MG/DL,TRIGLYCERIDES-91 MG/DL,HDL-36 MG/DL,LDL-80 MG/DL,VLDL-18.2 MG/DL
PERIPHERAL SMEAR-ANISOPOIKILO CYTOSIS WITH MACROCYTES,MACRO OVALOCYTES,MICROCYTES,TEAR DROP CELLS SEEN\
IMPRESSION-DIMORPHIC ANEMIA
RETICULOCYTE COUNT-0.7
HEMOGRAM-
HB-6.6,TLC-8000,N-76,L-13,M-09,E-2,PLATELET COUNT-1.5 LAKH/CUMM
CKD STAGE IV (EGFR -23ml/min/1.73m.sq) WITH ANEMIA SECONDARY TO CKD HFPER WITH HTN
TREATMENT :
DAY 1-
FLUID RESTRICTION <1.2 L/DAY
SALT RESTRICTION <2 GM/DAY
INJ LASIX 40 MG/IV/BD
INJ PANTOP 40 MG/IV/OD
NEBULIZATION WITH MUCOMIST 6TH HOURLY
DAY 2-
FLUID RESTRICTION <1.2 L/DAY
SALT RESTRICTION <2 GM/DAY
TAB LASIX 40 MG/PO/BD
INJ PANTOP 40 MG/IV/OD
NEBULIZATION WITH MUCOMIST 6TH HOURLY
TAB NODOSIS 550 MG/PO/BD
CAP ALPHA D3 0.25 MG /PO/OD
TAB SHELCAL 500 MG/PO/BD
INJ IRON SUCROSE 1 AMP IN 100 ML NS IV/OD AFTER TEST DOSE
DAY 3-
FLUID RESTRICTION <1.2 L/DAY
SALT RESTRICTION <2 GM/DAY
INJ LASIX 40 MG/IV/BD
TAB NODOSIS 550 MG/PO/BD
CAP ALPHA D3 0.25 MG /PO/OD
TAB SHELCAL 500 MG/PO/BD
TAB OROFER XT 5 MG/PO/OD
TAB AMLONG 5 MG PO/OD
DAY 4-
FLUID RESTRICTION <1.2 L/DAY
SALT RESTRICTION <2 GM/DAY
TAB LASIX 40 MG/PO/BD
TAB NODOSIS 550 MG/PO/BD
TAB SHELCAL 500 MG/PO/BD
INJ IRON SUCROSE 1 AMP IN 100 ML NS IV/OD AFTER TEST DOSE
