37 yr female with CKD

-

 SHORT CASE.

HALL TICKET NO - 1601006141

This is an online E-log book to discuss our patient's de-identified health data, after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through a series of inputs available global online community of experts with the aim to solve the patient's clinical problems with the collective current best evidence based inputs. This E-log book also reflects my patient centred online learning portfolio and your valuable inputs in the comments section.


My case.

Chief complaints.


A 37 year old lady, hailing from Nalgonda, home maker, came to the out patient department on the 21/04/2021, with the chief complaints of:

swelling of both legs since 1 year
and difficulty breathing after exerting herself since 3 months


History of Presenting illness.

Patient was apparently asymptomatic 1 year ago, she developed swelling over both feet. Gradual in onset, progressive, spread to abdomen trunk and face as well. The swelling was more prominent in the morning when she got out of bed. She later developed shortness of breath. SOB was aggravated on exertion and relieved by rest. SOB gets worse on lying down and relieved on sitting up straight.

Patient is a known case of HTN. 
Not a known case of DM, epilepsy, bronchial asthma.


General examination
Informed consent was taken from the patient.

Patient is conscious coherent and cooperative, moderately built and moderately nourished.

Pallor - present 
Icterus - no
Cyanosis -no
Clubbing -no
Koilonychia - no
Lymphadenopathy - no
Edema - present 

Vitals

BP - 140/80 mm Hg
Pulse - 84 BPM
Respiration - 16 cycles per minute
Temperature - afebrile ( 98.6 degrees Fahrenheit)

Systemic examination 

Cardiovascular system 
Palpation - apex beat shifted to left 6th intercostal space outside midclavicular line
Blood pressure is elevated (HTN)

Respiratory system 
Bilateral basal lung crepitations are heard sign of pleural effusion

INVESTIGATIONS CLINICAL FINDINGS AND DRUGS.



PEDAL EDEMA





ANEMIA ( PALLOR )






HEMOGRAM









RFT



UREA AND CREATININE ARE ELEVATED INDICATION OF RENAL FAILURE.


LFT







COMPLETE URINE EXAMINATION






ECG






ULTRASOUND ABDOMEN





DRUGS


FUROSEMIDE - LOOP DIURETIC
NICARDIA ( NIFEDIPINE )




PROVISIONAL DIAGNOSIS.

CHRONIC KIDNEY DISEASE CAUSING SECONDARY RETENTION OF WATER LEADING TO PLEURAL EFFUSION AND SOB.

TREATMENT.

  • PATIENT IS SUGGESTED TO MAINTAIN A LOW SODIUM DIET TO CONTROL SODIUM WATER RETENTION 
  • TABLET LASIX 40 mg BD
  • TABLET CLINIDIPINE 10 mg BD
  • TABLET NODOSIS ( ANTACID ) 300mg OD
  • TABLET SHELCAL 500 mg OD
    OTHER TREATMENT MODALITIES INCLUDE:
  • MAINTAINENCE HEMODIALYSIS
  • KIDNEY TRANSPLANTATION ( PATIENT'S ATTENDERS HAVE BEEN EXPLAINED ABOUT TRANSPLANTATION )
  • ANEMIA CAN BE CORRECTED BY RECOMBINANT ERYTHROPOIETIN 
  • OTHER COMPLICATIONS OF CHRONIC KIDNEY DISEASE MUST BE LOOKED OUT FOR AND TREATED ACCORDINGLY ( RENAL OSTEODYSTROPHY, VOLUME OVERLOAD, HYPERKALEMIA, METABOLIC ACIDOSIS, HYPERTENSION )

Comments

Post a Comment

Popular posts from this blog

PARAPARESIS OF THE LOWER LIMBS SECONDARY TO TB

-
Paraparesis of the lower limbs. Hello all, I am P.Vihar (Roll no 127) a student of 8th semester pursuing medicine at KIMS Narketpalli. Today I share, in this blog  my views and thoughts on a case   which our department of general medicine has shared, to help us achieve better understanding of the clinical cases. The link given below, is to the entire case details :- https://vaish7.blogspot.com/2020/05/medicine.html?m=1 MY VIEWS AND THOUGHTS ON THIS CASE. Here we see a 23 year old male patient with history of a sudden fall when he tried to get up to use the bathroom. Patient came to the hospital in this regard complaining of weakness in both lower limbs. After going through his history i have some questions in mind which i will write down below:- 1) His chief complaint was tingling and numbness in both lower limbs since 5 days. This makes me think of paresthesia in his legs, but when we talk about paresthesia there are many causes like herniated disc, tumor in the spinal cord, etc.. al
Read more

2023 (November) JRCPTB QIP Project Cycle - 3 Presentation.

-
Image
Inpatient care Quality Improvement Project.   The Inpatient care quality improvement cycle started with the goal of improving patient care by identifying lapses, and checking progress in 4 domains of clinical practice that impact the quality of inpatient care namely;    ·        History taking  ·        Clinical/ physical examination ·        Lab and imaging data analysis ·        Full case analysis   Using the online learning portfolios of the students of 2016 batch; which was divided into 4 quarters; these 4 domains were graded based on performance from 0-4. I collected this raw data and processed the data to represent it statistically (quarter mean and cumulative mean scores). Thus enabling us to check for progress/ changes in specific domains and overall clinical practice.   After processing the data, I systematically entered the data into an excel spreadsheet and made relevant tables/ graphs to represent our findings.  These online learning portfolios were selected for cycle 3. T
Read more

80 yr male

-
 80 yrs old Male came to casualty with  C/O loss of consciousness (for half an hour) C/O involuntary bowel and bladder incontinence and slurred speech since 4am today(19/12/21) HOPI Patient was apparently asymptomatic till 4:00am today got up from bed and walked to washroom ,while walking near the door at 4:00am,patient slipped and fell on the ground-sustained injury to back and head. He had loss of consciousness for half an hour and then regained.Conscious spontaneous with no involuntary movements,froth from mouth. H/O involuntary micturition and defecation present  H/O slurred speech present after fall On presentation patient is conscious,confused,slurred speech present. Past history  N/K/C/O HTN,DM,TB,epilepsy,CVA,CAD Personal history  Diet -mixed Appetite-normal Bowel movements-irregular  He is a toddy drinker and smokes chutta  Family history  Not significant  General examination  Pt is conscious  Vitals Temp-Afebrile  Bp-120/60mmHg PR-90bpm Spo2-99% on RA Systemic examination  CV
Read more