Skip to main content


26/M btech,completed 3yrs back non alcoholic and a non smoker , developed vomitings 4-5episodes on23rd December: yellow colored,non bilious,non blood stained contained foodparticles/water. Thenafter patient used to have vomitings every day 2-3episodes or at times multiple episodes for  one &half month i.e till feb 11th
   After 15days of onset of vomitings i.e in January patient went to Suryapet hospital and there for the first time he was said to have high bp-170mmhg and brain imaging was done .Used anti hypertensive drugs for 10days and stopped
On February 12th he presented with :
1-multiple episodes of vomitings a day before,2-he noticed decreased urine output since January
 3- intermittent shortness of breath on walking for long distance
4-spasm of both calves since 5-6yrs monthly twice/thrice only night times due to which he used to get up from his sleep
His creatinine was 15mg/dl
On February 13th he was referred to NIMS
 i/v/o renal biopsy.There his shortness of breath was increased from grade2 to grade4 NYHA and immediately started hemodialysis.6-7HD done at NIMS and then he came back to our hospital.They denied renal biopsy due to high risk of bleeding.since then he is on HD weekly twice and continuing anti hypertensive drugs(nicardia 20mgBD). since one month he is noticing pedal edema in between dialysis and also shortness of breath 2days after each dialysis associated with orthopnea PND and insomnia 
On  Thursday (30-07-2020) he came for his regular dialysis but he complained of shortness of breath even at rest, abdominal tightness and pedal edema for with he was admitted in AMC.

General examination:






            

INVESTIGATIONS:
On 30-07 -2020






On 08-09-2020
He again came for dialysis,
INVESTIGATIONS DONE:
Came with complaints of sob so was admitted for evaluation.








26/12/2020












DIAGNOSIS:
CKD ON MHD WITH HTN WITH B/L TRANSUDATIVE PLUERAL EFFUSION SECONDARY TO HD

Treatment:

Salt and water restriction
Inj.augmentin 625mg od
Tab nicardia10mg tid
Tab.pantop 40mg od
Tab.lasix 40mg bd
Tab.orofer xt od
Tab shelcal.hs od
Tab nodosis 550mg od
Tab zofer 4mg tid
Nebulisation with budecort and salbutomol 8th hrly
Bp/pr/temp/spo2 and I/O charting monitoring

Comments

Post a Comment

Popular posts from this blog

THESIS

Image
TOPIC: PREDICTORS OF OUTCOMES IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION AND HEART FAILURE ADMITTED TO A RURAL TERTIARY CARE HOSPITAL PROBLEM STATEMENT: HEART FAILURE is one of the leading cause of death at present all over the world. Inspite of the recent advances and extensive research being done in medical field we are unable to find the exact etiology and predictors of mortality and morbidity in many of the patients with HEART FAILURE and the current mode of treatment is only symptomatic. In a rural setup with limited resources: How far we can eliminate the diagnostic and therapeutic uncertainties that persist in a patient with heart failure and what best we can do to improve their outcomes. INTRODUCTION: Inspite of having advancement in field which helps in diagnosing pulmonary hypertension, it remains the disease that takes lot of time for diagnosis from the presence of first symptom, many patients are diagnosed only in advanced stage of disease. 1 Normal pressure in pulmon
Read more

BIMONTHLY INTERNAL ASSESSMENT - MAY 2021

Image
Section : 1  Please go through the patient data in the links below and answer the following questions: 1) Pulmonology (10 Marks)  A) Link to patient details: https:// soumyanadella128eloggm. blogspot.com/2021/05/a-55- year-old-female-with- shortness-of.html Questions: 1) What is the evolution of the symptomatology in this patient in terms of an event timeline and where is the anatomical localization for the problem and what is the primary etiology of the patient's problem? Symptomatology & event time line: SOB  Grade-II  on & off since 20 Years (exacerbations once in a year) ! Increased frequency & severity of exacerbations since 12 Years ! T2DM since 8 Years ! Anemia 5 yrs back treated with iron sucrose ! Generalized weakness & SOB Grade-II since 30 days ! HTN since 20 days ! Pedal edema & Facial puffiness since 15 days ! SOB Grade-IV & decreased urine output since 2 days Anatomical localization:  Lungs - COPD - SOB Grade- II COPD - PAH - RHF - Pedal edema
Read more

BIMONTHLY INTERNAL ASSESSMENT - DECEMBER

Image
1) A 55 year old man with Recurrent Focal Seizures Detailed patient case report here:  http://ushaindurthi. blogspot.com/2020/11/55-year- old-male-with-complaints-of. html 1. What is the problem representation of this patient and what could be the anatomical site of lesion ? A 55 year old male construction worker with T2DM who is a chronic alcoholic & smoker came with c/o weakness of right upper limb with involuntary movements of both right UL & LL secondary to ? right temporal lobe epileptogenic focus. 2. Why are subcortical internal capsular infarcts more common that cortical infarcts? subcortical infarcts are caused by occlusion of a penetrating artery from a large cerebral artery, most commonly from the Circle of Willis. These penetrating arteries arise at sharp angles from major vessels and are thus, anatomically prone to constriction and occlusion.  So subcortical infarcts are more common than cortical infarcts. https://www.ncbi.nlm.nih.gov/books/NBK534206/#:~:text=Lacuna
Read more