A 70 year old male came with chief complaints of bilateral pedal edema.

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A 70 years old male came to the opd with chief complaints of bilateral pedal edema since 3 weeks, shortness of breath since 2 weeks , decreased urine output since 12 days.

HISTORY OF PRESENTING ILLNESS 

Patient was apparently asymptomatic 3weeks back the he developed bilateral pedal edema which was gradually progressive extended up to knee and it is of pitting type.

He developed shortness of breath which was incidious and gradually progressive and of grade sob is intially grade 2 and at present progress to grade 4.

5 sittings of dialysis was done.

History of loss of appetite and Nausea.

History of hypertension since 10 years.

No history of fever

No history of burning micturation 

No history of diarrhoea 

PAST HISTORY 

Not a known case of diabetes mellitus, Asthma,epilepsy leprosy,CVD.

TREATMENT HISTORY 

NSAID abuse 

PERSONAL HISTORY 

Diet : Mixed 

Appetite : Decreased 

Sleep : Normal

Bowel moments :Regular

Bladder -decreased urine output 

Addictions:chronic alcoholic since 30yrs.

                  Tobacco smoking since 40 years.

FAMILY HISTORY 

Not significant 

GENERAL EXAMINATION 

Pallor: present.

Icterus: absent

Cyanosis: absent

Clubbing: absent

Lymphadenopathy:absent

Pedal edema: present(bilateral)

Vitals:

Temperature - 94*F

PR :- 104bpm

BP :- 100/80 mm Hg

RR:- 16cpm

SYSTEMIC EXAMINATION 

Respiratory system:

-Inspection:

Trachea -central

Chest appears bilaterally symmetrical and elliptical in shape

-Palpation:

Trachea central in position

Measurements 

AP  diameter :-16cms

Transverse diameter :-26cms 

-Percussion                Right              Left

Supraclavicular          R                    R

Infraclavicular            R                    R

Mammary                   R                    R

Axillary                      D                    D

Suprascapular             R                     R

Infrascapular               D                    D

-Auscultation 

Decreased breath sounds at Axillary and infrascapular.

CVS : S1S2 heard. No murmers

CNS:No focal neurological deficit. Cranial nerves are intact.

P/A: soft, non tender. Normal bowel sounds are heard.

INVESTIGATIONS

X-ray :- obscuration of bilateral costophrenic angle.

               Heart borders are obscured.

                Domes of diaphragm are obscured.

Impression:- bilateral pleural effusion.

23/12/2022

24/12/2022

5/1/2023

USG :- bilateral moderate pleural effusion with collapse of underlying lobes.

PROVISIONAL DIAGNOSIS 

Chronic renal failure with bilateral pleural effusion.

TREATMENT 

Injection lasix 40 mg iv BD

Injection expo 4000 IU once weekly, s.c

Injection iron sucrose100mg+100ml of n.s. , once weekly 

Injection Piptaz 2.5 mg IV, TID.

TAB nodosis 50 mg po BD

TAB shelcal 50 mg po BD

TAB Nicardia 10 mg po BD

Cap biod3 weekly once

TAB DYTOR 20mg po.BD

TAB chymorol forte po TID.

Intermitent NIV for 2 hours.

Salt (<2g/day) and fluid(<1.5lit/day) restriction.

Vitals monitoring regularly.

Inform sos.