A 70year male with on and off pedal edema

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Case presentation: 

A 70year male from Mothkur presented with complaints of 

1. swelling all over the body since 1 month

2. Difficulty in breathing since 2 days

3. Reduced urine output and not passing stools since 2 days

Patient was alright 1month back then he had swelling of the lower limb and he was confined to the bed. Swelling gradually progressed to all over the body for which they visited a hospital in Suryapet, got treated for 4 days took medications and went to their home. From 2 days he had complaints of not passing stools and reduced urine output. Difficulty in breathing even on rest, for which he came to our hospital for further evaluation.

Past history:

8 year back patient had history of swelling of lower limbs for which he came to KIMS Narketpally. He got dialysis one time took medications for 1 month and didn’t follow up as his son died (due to cancer). During this period he had on and off symptoms of pedal edema which got relieved on some medications given my RMP. 

k/c/o Hypertension (since 15years and on medication)

Not a known case of DM, asthma, tuberculosis, epilepsy, CAD.

PERSONAL HISTORY :

Mixed diet

Apetite  Normal

Sleep adequate 

Bowel and bladder movements regular

Non alcoholic and non smoker

GENERAL EXAMINATION:

No pallor, no Icterus, no clubbing, no cyanosis, no generalised Lymphadenopathy, generalised edema present

Vitals:

Patient is afebrile

Pulse rate: 116bpm, regular rhythm, normal volume and character.

Bp: 140/80 mmhg measured in right arm in supine position.

Spo2 : 89% on room air

Systemic examination:

CVS:- 

S1 and s2 heard , No murmurs

RESPIRATORY SYSTEM:

Wheeze on right side (infrascapular area)

Trachea position: central

Fine Basal crepts (right and left side inframammary and infrascapular, inter scapular areas)

P/A: soft, non tender.

CNS: NHFD

INVESTIGATIONS:

Serum creatinine: 4.5

Serum Na: 127

Urine. Na: 202

Urine creatinine: 31.7

 

TREATMENT:

Day 1: 

1. Fluid and salt restriction (<1.5 lt/day)

2. Inj. LASIK 40mg IV TID

3. Tab. METXL 25mg OD 

4. O2 inhalation to maintain spo2

5. Tab. NODOSIS 550mg BD po

6. Tab. SHELCAL- HD OD po

7. Tab. OROFER XT BD po

Day 2 to 6

CST   +

 AUGMENTIN 625mg BD po

AZITHROMYCIN 500mg BD po 

Day 7: 

1. Tab. LASIK 40mg BD po

2. Tab. MET XL BD po

3. Tab. AMIODARONE 100mg BD 

4. Tab. NODOSIS 550mg OD po

5. Tab. SHELCAL 500mg BD po

6. Cap. D3 0.25mcg OD po