60/F with Chronic Renal Failure.

 Case of 60yr/F with CKD associated with 

Left venticular Failure . 


N. Raveela 

Roll no. 95

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 comment box"

A 60 year old  female homemaker , from miryalaguda came to us yesterday morning with the 


Chief complaints:

65 year old female homemaker , resident of miryalaguda came to the OPD yesterday morning with the 


Cheif complaints


Swelling of hands and feet since 15 days 


Swelling of the face since 15 days 


Easy fatigability since 15days


Shortness of breath since 5 days initially grade 3 3 progreeeed to (grade 4)




HISTORY OF PRESENTING ILLNESS


Patient was apparently asymptomatic 15 days back then she developed pain and swelling in leg which was sudden in onset , gradually progressive which was aggravated on exercise and relevied by taking rest.


* she had swelling of hands and feet since 13days


* Facial puffiness since 5days


* c/o joint pains since 15 days , she is unable to walk and work for 4days.


No history cough , chest pain , 


No history of fever, burning micturation ,hematuria.


Daily Routine:-


She wakes morning at 7AM .At7:30 AM drinking honey and lemon water then watching TV and doing daily work.Having lunch (rice with curry) and At 8pm dinner( chapathis).




3 months ago , she started consuming protein powder for weight loss , she used to consume only one meal a day that is in the afternoon and used to drink protein powder both morning and evening. No h/o exercising** 


(Replaced her morning and evening meals with protein powder ) .


After fracture she stopped consuming protein powder.



PAST HISTORY


She is known case of diabetes and hypertension for the past 15years for which she is under regular medication.


*2 months ago : H/O fall due to sudden loss of balance breaking her left wrist for which she went to a local RMP and was suggested an Ayurvedic slab for the left wrist ! 


* Not a known case of thyroid ,TB , epilepsy, CVD etc.


* History of Right eye cataract surgery one year back .


* No history of blood transfusions


Menstrual history


Age of menarche - 13yrs


H/o Tubectomized 22yrs ago




PERSONAL HISTORY





Diet - mixed

Appetite - Reduced(since 5days)

Bowel and bladder movements are regular

Sleep is prolonged

Urine output is reduced

No known allergies 

No known addictions.


Family History


*Her elder brother passed away in a heart attack at the age of 40 years old.

*Her younger brother is a known case of diabetes 



GENERAL EXAMINATION


Patient is conscious, coherent and coperative examined under well lit and good ventilaton.


well built and moderately nourished




Vitals : 


Temperature: afebrile (98.3 degrees F) 


Pulse rate: 91bpm 


Respiratory rate :18cpm  


Blood pressure : 140/90 (as of today morning)


Spo2 -99% in room air







O/E:

Pallor : present

No icterus

No cyanosis

No clubbing

No koilonchya

No lymphadenopathies

Pedal edema: pitting type present


Clinical pictures


Pale lower palpebral conjunctiva. 







SYSTEMIC EXAMINATION : 

CVS:
S1 and S2 are heard
no thrills and no murmurs were heard

 Respiratory system examination
.

On inspection

  • Chest shape is elliptical
Bilateral symmetry of chest
Exapands equally on inspiration
Rate  and rhythm:34cpm
Trachea: central
No dilated veins and scars and sinuses

On palpation

Position of trachea central
Apex beat : 6 th left ics
Equal  expansion  of chest on respiration.
 No tenderness over chest

On percussion
Dull note in infraxillary,mammary, infrascapular. 
Resonant node heard





 On Auscultation:
 

Normal Vesicular breath sounds 
B/L Basal crepts in infra axillary, mammary, infrascapular. 


*-Abdomen:
no tenderness
no palpable mass
no hernial orifices
no free fluid
liver and spleen are not palpable
bowel sounds are heard

-CNS:
Conscious and slurred speech
normal gait
crainial nerves are normal
sensory system is normal
motor system is normal

INVESTIGATIONS







30/3/2022

31/3/2022
11.00Am




Provisional Diagnosis : ?Ckd with left venticular failure and posterior wall MI..???? 



 Treatment: 

On 29.03.22

1) TAB . Lasix 40 mg PO/BD 

2) TAB. Nodosis 500 mg PO/BD 

3) TAB. Shelcal CT 500 mg PO / OD 

4) TAB. Orofer XT 1 tab PO /OD 

5) TAB. PAN 40 mg PO/OD 

6) INJ. Erythropoietin 4000 IU SC. Weekly once

7) TAB. Nicardia 20 MG PO/TID  

30/3/22:
 Relieved from facial edema,edema in the leg was persistent. And was advised for dialysis. 
31/3/22:


9.00Am:Patients was gasping for air, and was hypotensive B. P 60/40.Pulse feeble.. 
Incubation Done. B.P was 90/40. Ecg showed ST depression in lead 2,V5, V6, avf
Depression of ST in lead avr. 
Time of Death:11.07am
Most probable cause of death  N STEMI  ..? 
Posterior wall MI?? 


















































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