60 year male with sob and b/l pedal edema

60yr old patient with ckd

November 30,2022

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the

-This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.

-Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs".

-This E log book also reflects my patient-cen

tred online learning portfolio and your valuable comments on comment box is welcome.

Nitin Raj

CHIEF COMPLAINTS: C/O facial puffiness,c/o sob,c/o b/l pedal oedema since 10 days

Mechanism of nsaids induced kidney injury

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534025/#:~:text=NSAID%20agents%2C%20selective%20and%20non,disorders%20to%20chronic%20kidney%20disease

HISTORY OF PRESENTING ILLNESS

- Patient was apparently asymptomatic 6 months ago later he developed back pain for which he took NSAIDS once in 2-3 days which was releived,later from last 10 days he developed facial puffiness,sob grade 2 and bilateral pedal oedema(pitting type) associated burning Micturition and abdominal distension

There Is no h/o of fever nausea vomiting diarrhea

HISTORY OF PAST ILLNESS

K/c/o HTN: 1month (on regular medication unknown)

N/k/c/o : DM,TB,EPILEPSY,CAD.

TREATMENT HISTORY:

He is on NSAID medication for lower back ache .

PERSONAL HISTORY:

DIET : Vegetarian

Appetite normal

Micturition normal

Bowel and bladder movements regular

ON EXAMINATION

Patient is conscious ,coherent and cooperative

well oriented to time,place and person

pallor

No icterus

No cyanosis

No lympahdenopathy

Pitting type of oedema(bilateral)

On the time of admission:

Temperature- 98.2 c/f

Pulse rate- 92 b/m

Respiratory rate- 20 cpm

Bp- 160/100 mmhg

GRBS- 126mg/dl

ON SYSTEMIC EXAMINATION

CVS-S1,S2 heard

No murmurs

RS- BAE +

ABDOMEN- inspection- scaphoid shape

No tenderness,skin is smooth and shiny,no scars,sinuses

Palpation- no local rise of Temperature,tenderness absent,guarding present,hernial orifice normal,fluid thrill absent,liver not palatable,seen not palpable

CNS- conscious,speech normal,no signs of meningeal irritation,sensory and motor system normal,gait- normal.

DIAGNOSIS- CHRONIC KIDNEY DISEASE SECONDARY TO NSAIDS ?

Investigations

SOAP NOTES : 22/11/22

S:facial puffiness since 10 days

SOB
Bilateral pitting oedema

O: vitals
     Temperature- 98.2 c/f

Pulse rate- 92 b/m

Respiratory rate- 20 cpm

Bp- 160/100 mmhg

GRBS- 126mg%

A: chronic renal failure secondary to NSAIDS

P: T. NICARDIA 20 MG PO BD
     T. NODOSIS 500 MG PO BD
     T. MET XL 25 MG PO BD
     T. OROFER XT PO BD
      T. SHELCAL PO BD

INJ ERYTHROPOIETIN 4000 IU S/C WEKLY ONCE AFTER DIALYSIS
T. LASIX 40 MG PO OD

High risk central line consent was taken

DIALYSIS

ON 23/11/22

PRE DIALYSIS

VITALS:BP: 180/80 MMHG

PR: 79 BPM

SPO2: 99%

RFT:

UREA-195

CREATININE: 17.2

URIC ACID: 7.7

HB: 6.5

DURING DIALYSIS:

BP: 180/60

PR: 89

SPO2: 99%

POST DIALYSIS:

BP: 160/70

ON 24/11/22

RFT:

UREA:114

CREATININE:10.0

URIC ACID:4.7

HB:9.1

SOAP NOTES : 23/11/22

   SOB subsided
   Bilateral pitting oedema
O: vitals
     Temperature- afebrile

Pulse rate- 96 b/m

Respiratory rate- 20 cpm

Bp- 160/100 mmhg

GRBS- 128mg%

A: chronic renal failure secondary to NSAIDS

P: T. NICARDIA 10 MG PO BD
     T. NODOSIS 500 MG PO BD

T. OROFER XT PO BD
T. SHELCAL PO BD