A 48yr old male came with chief complaint of chest pain and sob
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A 48yr old male patient who is a labour by occupation and a resident mothukur
Presented to the casualty with chief complaints of chest pain ans SOB
History of presenting illness
This patient was apparently asymptomatic 1 month back.then He developed bilateral pedal edema and Facial puffiness for which he visited hospital and was diagnosed with kidney failure and was advised immediate dialysis to which the patient refused at the time. He was managed medically
He then presented with SoB and chest pain 1 week back, and was then admitted and dialysis was performed.
3 sessions of dialysis have been completed since admission.
On 27 Jan he developed abdominal distention and slurred speech
PAST HISTORY
No history of DM, TB, Asthma, Epilepsy, CVA, CAD.
PERSONAL HISTORY
Appetite - reduced
Diet - mixed
Bowel - decreased
bladder - normal
Built -normal
Sleep - regular
Addictions -
Occasional alcohol consumer from
Occasional tobacco abuser
General examination
Pt is Conscious, Coherent and Co operative
Pallor - present
Icterus - absent
Cyanosis - absent
Clubbing - absent
Koilonychia - absent
Temp- afebrile to touch
BP-130/80mmhg
Pr-89/min
Spo2-96%
Rr-20/min
B/l-pedal edema present
Systemic examination-
CVS
S1 , S2 are heard , no murmers
Resp system
-normal vesicular breath sounds heard
Per abdomen -
On inspection- abdomen is distended
On palpation - no tenderness ,
Liver , spleen - not tender, not palpable
On percussion- dullness is heard 5cm lateral to umbilicus
CNS Examination
No Focal neurological deficit seen
INVESTIGATIONS
21th January
2D ECHO
As of 28 January
TREATMENT:
TAB. LASIX 40 MG PO BD
TAB. PAN 40 MG IV BD
TAB. NODOSIS 500 MG PO BD
TAB. ZOFER 4MG IV BD
TAB OROFER XT PO BD
TAB NICARDIA 10 MG PO BD
ING ERYTHROPOIETIN 4000 IV SC ONCE WEEKLY
MONITOR VITALS
On 29 January
Tab Quetiapine 25 mg /BD
Tab lorazepam 2 mg / sos ( if patient is unstable)
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