45 Year Old Female with B/L Lower Limb swelling and Shortness of Breath.

This is an online E logbook 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 an available global online community of experts to solve those patients clinical problems with collective current best evidence-based inputs. This e-log book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment box are welcome.
Ch Savanth Reddy
Roll no 16
Thank You Sasi Madam For The Guidance.
Date of Admission
29-8-21
Chief Complaints:
B/L Swelling of Legs since Two Years
Shortness of Breath since 1 Year
History of Present Illness
Patient was Apparently Asymptomatic 2 years back.
Then he developed swelling in Both the Legs near the Ankle.He Was then admitted in Hospital in Jan 2020 for Seven Days and the swelling Decreased and the swelling Decreased on medication.He continued the Medication for 3months and stopped due to Financial Reasons.
Then in Dec 2020 He started experiencing Shortness of Breath which was Aggravated on work and Relieved on taking rest and medication.
And Swelling which was previously limited to legs has now spread,resulting in facial puffiness,abdominal distension,and swelling of Upper limbs.
It was also associated with decreased appetite,vomiting,and Constipation.
So in Jan 2021 He was admitted in our Hospital and Dialysis was initiated through Central Line At Rt Femoral Vein and it Fell off after 4 times of dialysis .

Then in February New Central Line at Rt internal jugular Vein and was maintained for 3 months.
Then New iv line was started at Left IJV and maintained for 2 times of dialysis.
Then New iv line was started at Rt Femoral Vein and maintained for 2 dialysis
He then Went to NIMS,Hyderabad where peritoneal dialysis Was Done.
Patient undergone last dialysis on 20-8-21 in NIMS ,Hyderabad.
Then He was brought to our Hospital on
 29-8-21 .
Past History 
Diabetes since 10 years and he was taking Insulin Daily.
Hypertension since 2 years and was taking Nicardia,Arkamin.
Personal History
Diet - mixed
Appetite - decreased
sleep - adequate
Decreased Bowel  movements 
Alcoholic 2 years Back.
General examination :
Patient is conscious ,coherent ,cooperative and was well oriented to time ,place and person
at the time of examination.
He is examined in a well lit room, with consent taken
He is moderately built and well nourished
Pallor - absent
Icterus - absent
Cyanosis - absent 
Clubbing - absent
lymphadenopathy - absent
Edema - Present in Upper And Lower Limbs.
Vitals : 
Temperature  : Normal
Pulse rate - 84 bpm
Respiratory rate - 18 cpm
Blood pressure - 140/80 mmHg
SYSTEMIC EXAMINATION
S1 and S2 heart sounds heard
      NO murmurs and thrills
INVESTIGATIONS
On 29-8-21
On 30-8-21
On 29-8-21

Short PR interval and ST Deviation

Distended Abdomen

From Front
From Left
From Right
Edema 
B/l Pedal Edema (Pitting)
Edema of Upper limbs


https://photos.app.goo.gl/t2aYqZPuAo6c4KgM7
Provisional Diagnosis

Chronic Renal Failure

TREATMENT

1) Inj. LASI X 40mg /IV/TIC 

2) T- NODOCI 500mg 

3) T. OROFER XT PO/BD

4) T-SHELCAL 500mg POLOD

5) Inj.ERYTHROPOIETIN 4000 Ic weekly

6) Inj. IRON SUCROSE 1 amp in 100 ml NS /IV/ weekly on

7) Inj HAI 3/c, acc to GRBS
Salt Restriction(4gm/day)

8)T.Arkamin 0.1mg p.o B.D

9)Carvedilol 6.25 mg po/OD
 


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