General medicine case history 5

This is an online e-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.

A 57 year old male who is salesman by occupation presented to opd with chief complaints of b/L pedal edema since 15 days,itching (generalized)and loss of appetite.

Date of admission : 30/12/2021

History of present illness  :

Patient was apparently asymptomatic 3 months back and developed dizziness and pedal edema for left leg 2 months back then he visited local hospital there he diagnosed for DM and hypertension and underwent vascular surgery(thrombosis of popliteal artery) of left leg.Then he developed B/L pedal edema, generalized itching since 1month and visited our hospital. 

History of past illness  :

No similar complaints in the past

Patient is k/c/o DM, hypertension since 2 months and asthma since 5 years.

Patient is not a k/c/o  tuberculosis, epilepsy.

PERSONAL HISTORY: 

appetite : normal 

Bowel : regular

Micturition: normal 

Diet : vegetarian. 

Sleep : adequate 


FAMILY HISTORY: 

no similar complaints in the family


GENERAL EXAMINATION:

patient is conscious , coherent, cooperative 

No Pallor 

No Cyanosis

No Icterus

No lymphadenopathy

Pedal edema - present 

No Malnutrition

No Clubbing 

BP : 150/100 mmHg 

Pulse rate : 90 beats per min 

Respiratory rate : 20 cycles/min 

Temperature  : Afebrile

Spo2 at room temperature : 94%









Systemic examination: 

CNS : 

Patient is Conscious 

Speech normal 

CVS :

S1 , S2 sounds heard 

No murmers 

RESPIRATORY SYSTEM:

Position of trachea-  central

Breath sounds: vesicular 

PER ABDOMEN:

No tenderness, palpable mass 

Liver and spleen not palpable

PROVISIONAL DIAGNOSIS  :

Chronic kidney disease (diabetic nephropathy)on MHD

Investigations



30/12/2021





31/12/2021












4/01/2022



5/01/2022





Treatment  :

Inj lasix 40mg /Iv/tid
Tab nodosin 55 mg /po/bo
Tab shellal 500mg /po/od
Tab drofer-Xt /po/od  
Salt restriction <2.4gm/day 
Fluid restriction <1lit/day 
Tab nicardia 10mg /po/bd 
Tab Orofer-Xt po/OD 
Tab levocetirizine OD
Inj piptaz 4.5gm /IV /BD
Inj erythropoietin 4000IU weekly once






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