70 year old male with Acute on Chronic Renal failure ( Sepsis induced) Analgesic Nephropathy

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 A 70 year old male came to the casualty with c/o pedal edema since 1 n half month. which is progressive, pitting type, bilateral associated with facial puffiness.
no h/o SOB, Oliguria, abdominal distension.
pt complains he has HICCUPS since 15 days.
C/O VOMITING 10 days back, food particles as content, non projectile, bilious.
He usually have episode of Vomiting when he is travelling on bike or any other mode of transport.

H/O B/L pedal edema 2 years back, used medication for it and the edema subsided.

pt is a k/c/o HTN since 1 and half year.
not a k/c/o DM,CAD, ASTHMA, TB.

Appetite: Normal
Diet: Mixed 
Bowel movements: Regular.
Micturition: Urinary hesitancy + dribbling of urine+ no increased frequency of urine.
Sleep: Adequate.
Habits: Alcohol- 90 ml occasionally.
Tobacco: 1 Chutta/ day, stopped since 3 years.

No significant family history.

O/ E
Oedema of feet: B/L grade 2 pitting type.
Temp: Afebrile.
PR: 78bpm.
RR: 23 cpm.
BP: 200/100 mm hg 
SPO2: 98% on RA .

Systemic Examination
CVS: S1 S2 heard, no murmurs
RS: decreased Air entry on left ISA,IAA.
P/A: Soft, non tender.
CNS: Conscious, Speech- Normal, No signs of Meningeal Irritation. NAD.

PROVISIONAL DIAGNOSIS
? CCF/? RENAL FAILURE.

TREATMENT GIVEN:
Inj.LASIX 40 mg/ IV/ Stat.
BP charting 6 th hourly.
 
INVESTIGATIONS

ECG
CHEST XRAY PA VIEW
2 D ECHO

USG ABDOMEN
1/10/21
ABG
CUE
Albumin : +++
Sugar nil
Pus cells 4 to 5
Epithelial cells 3 to 4

DAY 2
A 70 yr old male with c/o pedal edema since 1 1/2 month

Subjective- pedal edema


Objective
Pt is c/c/c
Temp- Afebrile
BP: 180/90mm Hg
PR: 90 bpm
Cvs: S1S2 +
RS: BAE+ NVBS,
PA: Soft, non tender.Bowel sounds heard
CNS: NAD




Assessment: pedal edema 2° to ? AKI

Plan of care
Fluid restriction < 1.5 l/ day
Salt restriction< 2 g / day
Inj.LASIX 40 mg IV/ BD (8 am, 4 pm)
Inj.NEOMOL IV SOS( temp > 101F)
Tab. PCM 650 MG PO SOS
TAB. AMLONG 5 MG PO/ OD (8am)
Tab.MET XL 25 mg PO/OD 
Bp charting 4th hrly
I/O charting
Temp charting 6 th hrly
Inform SOS


DAY 3
A 70 yr old male with c/o pedal edema since 1 1/2 month

Subjective- fever spike


Objective
Pt is c/c/c
Temp- 99.7 F
BP: 150/90mm Hg
PR: 84bpm
Cvs: S1S2 +
RS: BAE+ NVBS, decreased on left IAA
PA: Soft, non tender.Bowel sounds heard
CNS: NAD




Assessment: pedal edema 2° to ? AKI

Plan of care
Fluid restriction < 1.5 l/ day
Salt restriction< 2 g / day
Inj.LASIX 40 mg IV/ BD (8 am, 4 pm)
Inj.NEOMOL IV SOS( temp > 101F)
Tab. PCM 650 MG PO SOS
TAB. AMLONG 5 MG PO/ OD (8am)
Tab.MET XL 25 mg PO/OD 
Bp charting 4th hrly
I/O charting
Temp charting 6 th hrly
Inform SOS

DAY 4
Subjective- No fresh complaints


Objective
Pt is c/c/c
Temp- Afebrile
BP: 140/90mm Hg
PR: 84bpm
Cvs: S1S2 +
RS: BAE+ NVBS,
PA: Soft, non tender.Bowel sounds heard
CNS: NAD




Assessment: pedal edema 2° to ? AKI

Plan of care
Fluid restriction < 1.5 l/ day
Salt restriction< 2 g / day
Inj.LASIX 40 mg IV/ BD (8 am, 4 pm)
Inj.NEOMOL IV SOS( temp > 101F)
Tab. PCM 650 MG PO SOS
TAB. AMLONG 5 MG PO/ OD (8am)
Tab.MET XL 25 mg PO/OD 
Bp charting 4th hrly
I/O charting
Temp charting 6 th hrly
Inform SOS

DAY 5
WARD CASE 
A 70 yr old male with c/o pedal edema since 1 1/2 month


Subjective- Acute on Chronic Renal failure (Sepsis induced) Analgesic nephropathy


Objective
Pt is c/c/c
Temp- Afebrile
BP: 140/90mm Hg
PR: 82bpm
Cvs: S1S2 +
RS: BAE+ NVBS,
PA: Soft, non tender.Bowel sounds heard
CNS: NAD



Assessment: Acute on Chronic Renal failure ( Sepsis induced) 
analgesic nephropathy

Plan of care
Fluid restriction < 1.5 l/ day
Salt restriction< 2 g / day
Inj.LASIX 40 mg IV/ BD (8 am, 4 pm)
Tab. PCM 650 MG PO SOS
Tab CLINDIPINE 10MG/PO/OD
Tab.MET XL 12.5 mg PO/OD 
Bp charting 4th hrly
I/O charting
Temp charting 6 th hrly.


WARD CASE 
DAY 7
A 70 yr old male with c/o pedal edema since 1 1/2 month


Subjective- Pedal Edema , Periorbital edema


Objective
Pt is c/c/c
Temp- Afebrile
BP: 150/90mm Hg
PR: 68bpm
Cvs: S1S2 +
RS: BAE+ NVBS,
PA: Soft, non tender.Bowel sounds heard
CNS: NAD


Assessment: Acute on Chronic Renal failure ( Sepsis induced) Analgesic Nephropathy

Plan of care
Fluid restriction < 1.5 l/ day
Salt restriction< 2 g / day
Inj.LASIX 40 mg IV/ BD (8 am, 4 pm)
Inj Neomal Iv Sos ( If temp > 101 F)
Tab. PCM 650 MG PO SOS
Tab CLINDIPINE 10MG/PO/OD
Tab Nicardia 20mg PO/BD ( 8AM --- 8PM)
Tab.MET XL 50 mg PO/OD 
Bp charti







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