A 60year old with Decreased urine output

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

 A 60year old lady came to casuality with chief complaints of

Facial puffiness since 3 days

Swelling of legs since 3 days.

Reduced urine output since 2 days

Patient was apparently asymptomatic 3 days back then she developed facial puffiness, swelling of both the legs upto knee which is aggravated on walking without any relieving factors along with it she also had swelling of both the hands upto forearm. The following day her urine output is reduced to very minimal amount. she had 2 episodes of Vomitings on the same day with non bilious, non projectile associated with food contents. 

On presentation She is drowsy with Generalized weakness and muscle cramps. 

No history of fever/cough/ shortness of breath/ burning micturition. 

She is a known case of Hypertension since 5 years and on medication (ATENOLOL 50mg).

Personal history:

She takes mixed diet

Normal appetite 

Adequate sleep

Decreased urine output (100ml/24hr)

No addictions

GENERAL EXAMINATION:

Patient is drowsy

No pallor, No Icterus, No cyanosis, No clubbing, No lymphadenopathy and 

bilateral pitting type of pedal edema is present






VITALS:

Patient is afebrile

Pulse rate: 76bpm, regular, normal volume and character

Bp: 140/100 mmhg

RR: 22cpm

Spo2: 96% on room air

Grbs: 159mg/dl

ON EXAMINATION:

P/A: 

Soft and Mild tenderness in right hypochondrium, epigastric and umbilical region.

No rigidity

CVS:

Trachea central

Apical Beat: 6th ICS midclavicular line

 S1, S2 heard and No murmurs 

CNS: NFND

Respiratory: 

Bilateral air entry +

Crepts + in right mammary and infra mammary and infrascapular areas

INVESTIGATIONS:


 



                    DYSMORPHIC RBC IN URINE




DIAGNOSIS:

RAPIDLY PROGRESSIVE GLOMERULO NEPHRITIS

TREATMENT:

1. Inj. LASIX 40mg iv/bd

2. IVF NS continuous infusion @urine output +30ml/hr

3. ORS sachet in 1lt water daily

4. Tab. AMLONG 5mg OD

5.  Inj. ZOFER 4mg sos


https://youtu.be/0GINcAzWJjI


https://youtu.be/O9Y1CJTA65U


https://youtu.be/8S5pRvyDAVg



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