A 60 year old man with pedal oedema since 15 days, dypnea since 5 days, fever since 5 days.

 A 60 year old man, who worked as a lorry driver, presented to the hospital with-

• Pedal oedema of since 15 days,

• Dyspnea since 5 days,

• Fever since 5 days,

• Decreased urine output since 3 days,

Date of admission - 2/2/22

HISTORY OF PRESENT ILLNESS

• Patient was apparently asymptomatic 15 days back.

• Patient wakes up at 6am every morning. He has his lunch at 2pm. He sleeps in the afternoon. He has dinner at 9pm and sleeps by 10pm.

•Patient is an ex lorry driver and lives a very sedentary life. 

• 15 days ago, they developed pedal oedema of pitting type — which extended upto ankles.

• They also presented with fever, which was continuous since 5 days.

• Patient also presented with grade 4 shortness of breath since 5 days.

• Vomiting of one episode which was non projectile 5 days back.

• Patient also suffered with uncontrolled hemoptysis since 5 days back. 

• 3 days ago, when the pt. was undergoing dialysis, the patient suffered from a cerebro vascular accident.

 

PAST HISTORY

• The patient suffers from Diabetes Mellitus since 15 years.

• The patient suffers from Hypertension since 2 years.

• His Hypertension was always apparently under control with medication.

• The patient suffered from Tuberculosis about 15 years back.

• The patient doesn't suffer from asthma and epilepsy.

• They were never involved in any kinds of accidents.

• They have never undergone any surgeries.

FAMILY HISTORY

• There is no incidence of similar symptoms in any other member of his family. 

• He seems to be the first person to suffer with DM in his family. 

• All the deaths in the family seem to be of natural causes.

• There are no genetic disorders or congenital deformities in his family to his knowledge.

DRUG HISTORY

• On equiry, the patient refused to have taken any sorts of steroids, oral diabetes drugs, diuretics, ergot derivatives, monoamine oxidase inhibitors, hormone replacement therapy or contraceptive pills — prior to coming to the hospital.

• The was put on DM medication 15 years back which was discontinued for a long time.

PERSONAL HISTORY

• The patient consumes a mixed diet of vegetarian and non vegetarian food.

• Since his illness, the patient has been only taking vegetarian food.

• The patient has poor appetite.

• They appear to be adequately nourished.

• Gradual decrease in micturition since the onset of illness.

• Bowel movement is constipated.

• They apparently have had the habit of drinking (unspecified amount) since 30 years.

• The patient is a non smoker and no habit of pan chewing. 

ALLERGY HISTORY

• Patient is not allergic to any known drug or food.

• There is no known allergy to dust or pollen in the patient.

GENERAL EXAMINATION

• The patient is concious, coherent and cooperative.

• On examination, patient's mood appears to be normal.

• They are obese. 

• The patient has oedematous face.

• Patient is unable to walk. 

• There is no lymphadenopathy present.

• There is no presence of clubbing.

• The patient has icterus.

• JVP sign unable to notice because of dialysis line insertion.

• There is oedema in both of their legs - pitting type.

• No decubitus sores are present.

• Patient has pallor and pale tongue; appears to be slightly anemic. 

• Patient appears to be mildly dehydrated.

• Vitals (on examining)

      Temperature- 99.3°F

      Respiratory rate- 26 cpm

      Pulse Rate- 85 bpm.

      S1 and S2 are heard. 

      spO2- 99%

      Blood Pressure is 140/80 mmHg.

      BAE +ve

      S1 S2 heard

PROVISIONAL DIAGNOSIS

Chronic Kidney Disease.

INVESTIGATIONS

FINAL DIAGNOSIS

Chronic Kidney Disease secondary due to Diabetic Nephropathy.

TREATMENT

1) Salt restriction <2.4 GM/day.

2) Fluid restriction < 1 lit / day.

3) Tab Lasix 40 mg.

4) Tab. SHELCAL 500 mg.