50 yr old farmer with decreased urine output


Chief complaints 

C/o SOB since 1 week 

C/o swelling in the legs 

C/o decreased urine output 


HOPI

A 50 yr old Farmer doing his regular work, of driving tractor till one week ago when he had sob with sweating, taken to a doctor outside ,where his grbs was recorded low ,was revived with eating a chocolate only, but he continued to take his oha even after that,rft showed increased creatinine,since 3 days his symptoms aggrevated and was brought here for further management ,2 sessions of dialysis 

1 st -19/2/22 from 10 am to 2 pm , 2 nd - 20/2/22 were done  



PAST HISTORY 

known case of DM since 3 years on medication 

HTN since 6 months (giddiness first symptom )

NO H/o asthma ;TB;EPILEPSY



PERSONAL HISTORY 

Marital status - married 

Occupation - Farmer 

Appetite - Normal 

Diet - Decreased appetite 

Bowel and bladder movements - regular

Addictions - 

Chronic alcoholic since 20 years daily 180 ml.

Chronic smoker since 20 years  daily 2-4 beedis per day.

No significant family history .


GENERAL EXAMINATION :

Patient is conscious , coherent, cooperative 

Pallor positive 

No icterus , cyanosis , lymphadenopathy, edema .



Systemic examination 


VITALS

BP : 120/ 80MM HG

PR : 86/ MIN

RR : 16/ MIN

SPO2: 98% on RA

GRBS : 105 mg/dl


SYSTEMIC EXAMINATION

CVS : S1, S2 +

RS : BAE +

P/A : soft , nontender 

CNS : No findings 



Investigations 

Blood group 
A positive 
CBP 
Hb - 6 
TC - 15,200 
N- 90 
L-05 
E - 02 
M- 03 
B-00
 SEROLOGY- NEGATIVE 

LFT - 
TB- 1.24 
DB -0.30 
SGOT - 15 
SGPT - 19 
ALP -198 
TP - 6.3
ALB -3.5

RFT - 
UREA - 271 
CREATININE - 12.0
CALCIUM - 7.7 
PHOSPHORUS -8.4
SODIUM - 133 
K- 4.9
Cl - 96 


SERUM IRON 
86 UG/DL 

TROP I 
NEGATIVE 
 
BLOOD SUGAR -FASTING 
FBS - 217 








Provisional diagnosis 
ACUTE LVF 2 TO LATERAL WALL MI ? With CKD 2 to DIABETIC NEPHROPATHY ?
WITH K/C/O DM AND HTN WITH PULMONARY OEDEMA 

Treatment 

1) INJ LASIX 40 mg/Iv/tid 
2)INJ pan 40 mg Iv/OD 
3) Tab nodosis 500 mg PO/BD 
4) tab shelcal c PO/OD 
5) tab orofer xt PO /OD 
6) INJ HAI s/c 8 am -2pm-8 pm 
7) monitor vitals and check Grbs 4 TH hourly 






































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