42yr old male with swelling of lower limbs

A 42yr old male resident of chityala electrician by occupation presented to the Opd with chief complaints of 

Swelling of the lower limb upto ankle since 5 days.

Shortness of breath since 4 days.

Numbness and tingling sensation of limbs with associated weakness since 4 days.

History of presenting illness :

Patient was apparently asymptomatic 3 years back when he developed generalised anasarca sudden in onset and gradually progressive in nature for 5 days, for which he went to a tertiary care hospital and was diagnosed with chronic kidney disease with associated hypertension( serum creatinine was around 5mg/dl) for which he was on medication for 6 months. On subsidence of the symptoms he stopped the medication.

On 1/6/23 he came to the opd with complaints of lower limb edema upto ankle since 5 days with associated shortness of breath ( grade 4 according to NYHA Classification)for  4 days, which was insidious in onset, gradually progressive in nature.

Tingling and numbness in the legs for 4 days which made him difficult to walk.

Past history:

Known case of hypertension since 3 years.

Not a known case of DM/CAD/ASTHMA/TB/EPILEPSY

Personal history:

Decreased appetite since 10 days

Adequate sleep

Normal bowel and bladder movements

Addictions - smoking history for 10 years 3 years back, alcohol consumption occasionally


General examination 

Patient is conscious coherent well oriented to time place person

Poorly built and nourished

No cyanosis clubbing icterus pedal edema lymphadenopathy







Vitals :

Pluse rate 
Bp
Temp afebrile 
Respiratory rate

Systemic examination :

CVS system

No thrills
Cardiac sounds are heard
No cardiac murmurs

Respiratory system

No dyspnoea 
No wheeze
Trachea is centrally positioned 
Vesicular breath sounds
No adventitious sounds 

Abdomen 

Scaphoid shape abdomen 
No tenderness, palpable mass
Normal hernial orifices
Non palpable liver, spleen
No free fluid 
Bowel sounds heard

CNS 

Conscious and alert
Normal speech 
No signs of meningeal irritation
Reflexes 
                    Right      Left
Biceps            +2        +2
Triceps           +2         +2
Supinator       +2           +2
Knee              +2           +2
Ankle              +2          +2

Investigations :

10-06-2023












16-06-2023

Cbp
Hb 5.6gm/dl
Tlc 9500
Platelets 1.71 lakh 

Rft
Creatinine 6
Urea 85mg/dl
Uric acid 3

Serum electrolytes 

Sodium 141
Potassium 3
Calcium 7.5
Chloride 103

Provisional diagnosis:

Chronic kidney disease on dialysis k/c/o hypertension since 3yrs 

Treatment :

10-06-2023

Tab NODOSIS 500mg/PO/BD
Tab OROFER XT/PO/OD
Tab SHELCAL 500mg/PO/OD
Tab AMLONG 5mg PO/OD
Cap BIO D3 PO once a week 
Inj ERYTHROPOEITIN 4000 subcutaneously once a week

14-06-2023

Fluid restriction <2lit /day
Salt restriction <2g/day
Tab LASIX 20mg PO/BD
Tab NODOSIS 500mg/PO/BD
Tab OROFER XT/PO/OD
Tab SHELCAL 500mg/PO/OD
Cap BIO D3 PO once a week 
Inj ERYTHROPOEITIN 4000 subcutaneously once a week

15-06-2023

Fluid restriction <2lit /day
Salt restriction <2g/day
Tab LASIX 20mg PO/BD
Tab NODOSIS 500mg/PO/BD
Tab OROFER XT/PO/OD
Tab SHELCAL 500mg/PO/OD
Cap BIO D3 PO once a week 
Inj ERYTHROPOEITIN 4000 subcutaneously once a week

16-06-2023

Fluid restriction <2lit /day
Salt restriction <2g/day
Tab LASIX 20mg PO/BD
Tab NODOSIS 500mg/PO/BD
Tab OROFER XT/PO/OD
Tab SHELCAL 500mg/PO/OD
Cap BIO D3 PO once a week 
Inj ERYTHROPOEITIN 4000 subcutaneously once a week 

17-06-2023

Fluid restriction <2lit /day
Salt restriction <2g/day
Tab LASIX 20mg PO/BD
Tab NODOSIS 500mg/PO/BD
Tab OROFER XT/PO/OD
Tab SHELCAL 500mg/PO/OD
Cap BIO D3 PO once a week 
Inj ERYTHROPOEITIN 4000 subcutaneously once a week

18-06-2023

Fluid restriction <2lit /day
Salt restriction <2g/day
Tab LASIX 20mg PO/BD
Tab NODOSIS 500mg/PO/BD
Tab OROFER XT/PO/OD
Tab SHELCAL 500mg/PO/OD
Cap BIO D3 PO once a week 
Inj ERYTHROPOEITIN 4000 subcutaneously once a week




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