48 year old male with shortness of breath, altered sensorium, decreased urine output


M. Sri Nithya

Roll. No-86


 Patient came with the complaints of  sob since 1 day, 

Decreased urine output since 1 day

Altered sensorium since 2 hrs

B/l Pedal edema on and off since 1 year


Hopi-

Patient was apparently asymptomatic 1 yr back then he developed b/l pedal edema , on and off  and was on conservative management. Since then, he was diagnosed with hypertension using tab. Telmisartan 40 mg since 1 year.

Since yesterday night patient is having is having sob grade 3 to grade 4,which is sudden in onset and gradually progressive, associated with PND, not associated with chest pain or sweating.

No c/o fever, vomitings or loose motions

.

Past history -

Not a k/c/o DM, tb , asthma , epilepsy, thyroid disorders, cad or CVD.


History of alcohol and smoking present since 25 years


Family History

There is no significant family history


On examination-

There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy

B/l pedal edema present, pitting type extending up to the knee


Temp- 98. 6F

PR-86 Bpm

RR- 20 cpm

Bp- 110/80 MMHG

Spo2- 46% on RA

Grbs- 101 mg%


Systemic examination -

CVS- S1, S2 Present, no murmurs

RS- BAE Present,

b/l wheeze present in infraaxillary, mammary, inframammary

Normal vesicular breath sounds present

Crepts present in b/l inframammary areas

P/A examination - soft, nontender

CNS EXAMINATION - NORMAL 

GCS SCORE - E4V5M6


Investigations -

Ecg- on the day of admission 











ECG on 13/3/23


Serology - negative

Blood group - A positive 


Provisional diagnosis -


Chronic renal failure with type 1 respiratory failure with severe metabolic acidosis. 


Treatment -

Inj. Lasix 40 mg iv stat

Inj. Sodium Bicarbonate 150 meq iv stat

Nebulisation with duolin and budecort stat 

Hemodialysis 

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