A 58yr old male presented to casualty complaining of Shortness of breath grade 4 since 4-5 days worsening since 2 hours
Decreased urine output since 4-5 days
Pedal oedema on and off since 6 months
Now subsided ( outside medications )
He was apparently alright 8 years back developed pedal oedema and shortness of breath and was taken local hospital and was diagnosed to be diabetic and hypertensive and chronic kidney disease with baseline creatinine of 2.5mg/dl
He had recurrent episodes of sob and was admitted 1/2 times and was managed symptomatically
Since 10-12 days he developed fevers of high grade intermittent type not associated with chills, a/w cough with expectoration, scanty ( occasionally)
Decreased urine output since 4-5 days, no history of lower urinary tract symptoms ( urgency, hesitation, frequency, post voi dal residue )
And was also diagnosed with peri anal abscess/pilonidal sinus and was referred to our hospital for further management
On admission
Patient conscious
BP - 130/90
PR - 112
Spo2 95% on RA
CVS : S1,S2 present
RS : BAE +
B/l Expiratory wheeze in infraclavicular are
Inspiratory crepts in IAA right side
P/A : soft non tender
BS+
CNS : No FND
ABG
PH 7.2
Pco2 : 12.1
Po2 : 111
Hco3: 5.1 ( gave correction
50meq stat
100meq through 100ml NS )
USG ABDOMEN:
Kidney size
Right : 8.2 X 3.5
Left : 7.5 X 3.2
Grade 4 RPD
RFT
Urea : 311
Creatinine : 7.1
Sodium : 132
Potassium : 6.0 ( gave correction )
Cloride : 104
Hemogram
Hb : 4.5gm%
TLC : 22,750
Plt : 3L/mm3
Plan : Hemodialysis
Comments
Post a Comment