41YR MAN WITH HEART FAILURE AND NEPHRITIC SYNDROME

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 is welcome.

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

Comments

Post a Comment

Popular posts from this blog

BIMONTHLY ASSESSMENT FOR THE MONTH OF MARCH -2021

Image
BIMONTHLY ASSESSMENT FOR THE MONTH OF MARCH 2021. This is my submission for the Bimonthly internal assessment for the month of March " The questions to the cases being discussed can be viewed from the link below  1. Please go through the patient data in the links below and answer the following questions: https://ashakiran923.blogspot.com/2021/03/60-years-old-male-fever-under-evaluation.html?m=1 a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?How specific is his dilated superficial Abdominal vein in making diagnosis? Based on the clinical symptoms and signs, the clinical diagnosis of the patient can be-  UTI with cirrhosis of liver with portal hypertension.  b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? What is the cause of his hypoalbuminemia?Why is the SAAG low?           ...
Read more

A 70 YR OLD MAN WITH ENLARGED HEART

Image
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 is welcome. Here is a case I have seen :  Unit 3 Interns- Harsha Sreeja  Archana  Kalyan  Sahithi Jeeharika Dr Raveen - PGY1  Dr Chandana - ICU PG Dr Aashitha - PGY2  Dr Aravind - PGY3  Dr Vamshi - PGY3  Dr Hareen - SR  Dr Praveen Naik - Ass Prof  Introduction Introduction: Ischaemic heart disease occurs when the myocardial oxygen supply is does not meet the myocardial oxygen supply. Here, we present a case of a 70 year old man with a history of CAD...
Read more