42YR M

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47 YR MALE WITH ? CKD ( DIABETIC NEPHROPATHY) , ? HEART FAILURE

A 47yr old male auto driver by occupation came for regular day care dialysis

History of Presenting illness - 

Patient was apparently asymptomatic 8 years ago

8 years ago - During a regular checkup he was found to be Hypertensive

6 years ago - He had complaints of generalized weakness and weight loss 

He was diagnosed to be diabetic

5 years ago - He was diagnosed with Acute pancreatitis

1month back - Pt developed pedal edema, progressed gradually to knees along with Facial puffiness

Shortness of breath 

Grade II-III progressed to Grade IV along with orthopnea and PND 

Since 4days-Decreased urine output

Chest pain on right side since 3days,which subsided on medication.

No c/o palpitations, giddiness ,fever, cold, cough, burning micturition. 

PAST HISTORY -

Known case of Hypertension since 8years on Tab Olmesartan 20mg OD

Diabetes mellitus since 6 yrs on Tab Glimy M2 OD

H/O Acute Pancreatitis 5 yrs ago

Not K/C/O TB, Epilepsy, Asthma, CAD.

Personal history

Appetite- Decreased

Bowel movement- Regular

History of alcohol intake stopped taking alcohol five years back. 

Smoking stopped 5 yrs ago

On examination

Pt is C/c/c

 Pallor present,No Icterus, Cyanosis, Clubbing, Lymphadenopathy

Edema of feet + 

Vitals

Pr: 94bpm

Bp: 150/100

SpO2: 97% at RA

Temp - Afebrile

Systemic examination

CVS - S1,S2 +

RS - BAE +

CNS - NAD

Investigations

Serology - Negative

RBS - 377mg/dl

Provisional Diagnosis - ? CKD ( Diabetic Nephropathy) ; ? HEART FAILURE

Treatment

Fluid restriction (<1L/day)

Salt restriction (<2g/day)

Inj· LASIX 40 mg IV TID, if Sbp > 100 mmhg.

Inj. Pantop 40 mg IV/BD.

Inj. Actrapid + NPH s/c acc to GRBS

Tab. CARDACE 2.5mg - PO/BD

Tab. CARVEDIOL 3.125mg PO/OD.

Tab. ECOSPIRIN - 75mg PO/OD .

Tab. ATORVAS -10 mg HS.

O2 Inhalation SOS.

BP/PR charting 2nd hourly.

GRBS charting 6th hourly

Strict I/O charting.

Daily weight monitoring.

Clinical findings.

Cxr pa view

Ecg

2d echo

Investigations