47 yr male with SOB

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A 43 year old male patient, hailing from Kattangur, who is in agriculture as occupation, was admitted to the ICU with chief complaints of :

Shortness of breath since yesterday night.

History of presenting Illness :
Patient was apparently asymptomatic until yesterday night, then suffered from shortness of breath, sudden onset, severe (Orthopnea +; Paroxysmal Nocturnal Dyspnea +) 
He was brought to the hospital and was admitted in the ICU where he was put on CPAP to maintain ventilation. 

Past history :
Patient is a k/c/o DM. 
He was diagnosed at the age of 23, when he visited the hospital complaining of polyuria. He has been using oral hypoglycaemic drugs for his DM. 
He is a k/c/o HTN since 6 years. 
He was diagnosed with HTN when he visited the hospital complaining of pedal oedema. 
Patient was out in NICARDIA, ARKAMIN & CLONIPHENE  for his HTN. 
His doctor explained to him that his pedal oedema was due to his underlying diabetes, and that it would subside by itself. 
The oedema resolved temporarily, but began again shortly. 
Patient had similar complaints of SOB in the month of April 2021, when he was admitted in Yashoda hospital, as he was SARS- CoV2 positive. He was managed conservatively. 

Patient developed pedal edema again 3 days back, associated with decreased urine output and shortness of breath. 
SOD was gradually progressive and he was brought to the hospital at 5 AM.

Past history :
Patient is a k/c/o CKD on MHD with DM and HTN.
He was on dialysis at NIMS panjagutta, but changed to KIMS narketpally as it was closer to his residence.
He has underwent 24 sessions of dialysis at our hospital.

Vitals :
BP - 180/110 mm Hg
PR - 96 BPM
Spo2 - 92 % (RA)
GRBS - 126 mg/dL
RR - 18 cpm

Pt is distressed, showing difficulty breathing.
He was shifted to ICU from casuality and was put on CPAP.
His saturations improved.

CVS - S1, S2 +; no murmurs 
RS - BAE +, crepts heard in IAA, ISA
P/A - soft, non tender
CNS - Intact

Treatment :

1. Fluid restriction < 2L / day
2. Salt restriction < 2 grams/ day
3. Tab. LASIX 40 mg BD
4  Tab. ARKAMIN 0.1 mg BD
5. Tab. NICARDIA 10 mg BD


Investigations 

2 D Echo

Previous investigations :

Renal biopsy was done at NIMS 

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