41YR MAN WITH HEART FAILURE AND NEPHRITIC SYNDROME

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Here is a case that I have seen:

GM unit 3 admission on 17/2/21

Interns:

Harsha

Jeeharika

Kalyan

Archana

Sreeja

Dr.Raveen PGY1

Dr.Aashita Kashyap PGY2

Dr.Araving PGY3

Dr.Vamshi PGY3

Dr.Hareen SR

Dr.Praveen Naik Asst.Prof

Dr.Rakesh Biswas HOD

41/M presented to OPD with

the complaints of  

Dyspnea on exertion since 1 year

Productive cough since 1 year, Bilateral pedal Edema  since 15 days, 

Facial puffiness since 10 days

Lower back pain since one week. 

Orthopnea since 4 days 

41-year-old man maestri by occupation and also a fisherman at a local village. His wife who was diagnosed with breast carcinoma and was operated here 1 year back.

He has  two kids - elder son is a mechanic,  younger daughter studied till 9th standard. Since 1 year he has been having dyspnea on exertion, he started finding it hard  to walk for more than hundred metres

He started having  productive cough with scanty mucoid sputum,  especially in winter season, which wasn't blood tinged.

 He visited a local hospital where in he was diagnosed with lung infection and was on ATT for 4 months during the period he had orange coloured urine (?ATT).

 He has been having bilateral lower limb Edema since 15 days, facial puffiness since one week, lower backache since one week orthopnoea since four days,

 He went to a local hospital for these complaints and  was diagnosed to be hypertensive one week back and was  put on tablet TELMA 40 MG OD tablet, 

DYTOR 25 mg OD 

B/L ear discharge since 1 month, for which he has been using oral medications on and off. 

Chronic since 22years -1pack per day (20 pack years)

Chronic alcoholic since 22years -90ml whiskey per day ..his last drink was in last week

On examination: 

Patient was conscious, coherent, co-operative 

Thin built and moderately nourished 

Cyanosis present on tongue 

BP: 170/80mmhg

PR: 98bpm

RR: 18cpm

SPO2: 98% at RA

GRBS : 128mg/dl

Afebrile to touch

Systemic examination: 

CVS: 

JVP raised, 

Palpable P2

Palpable apex beat 

Apex beat + in Left 6th ICS, 0.5cm from MCL

Pansystolic murmur+

Respiratory system:

Bilateral inspiratory crepts in IMA, IAA, ISA

Expiratory wheeze + in Bilateral ISA

P/A: soft, non - tender 

Bowel sounds +

CNS: normal 

Lab investigations:

review 2D echo on 23/2/21:

Spot urine :

Protein-181 mg/dl

Creat-42.7 mg/dl

U/C-4.3

Sodium-160 mEq/L

Potassium-18.8 mEq/L

Chloride-235 mEq/L

Diagnosis : 

1.Heart failure with moderate PAH

2.?nephritic syndrome,

3.?H/O pulmonary kochs (?ATT for 4 months)

Treatment :

Fluid restriction <1L/day

Salt restriction <2g/day

Inj.MONOCEF 1gm IV BD

Inj.LASIX 40mg IV BD

Inj.PAN 40mg IV OD

Inj.Thiamine 1Amp in 100ml NS IV TID

Nebulization with MUCOMIST 6th hrly

Monitoring vitals

Temperature charting (tepid sponging SOS)

19/02/21:

20/02/21:

ENT Referral:I/V/O Ear discharge

21/02/21:

22/02/21:

Hemogram at 7am

RFT at 7am

RFT at 2pm

23/02/21

Urine microscopy of the patient

Here the link of this case discussion:

https://youtu.be/eDX6A-kVmJc