A 80/M WITH CKD WITH A/E OF COPD CBBLE UDHC SIMILAR CASES

 


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 

Chief complaints
Came to casual the with complaints progression of shortness of breath (grade 2 since 10 days, grade 5)

History of presenting Illness 
Patient was apparently asymptomatic 10 days back then he had insidious onset shortness of breath grade 2 not associated with any orthopnea and pnd relieved on taking bronchodilators and exacerbated to sudden oncet grade 4 (stopped taking bronchodilators 2 days back)

H/O pedal edema on - off since 4mo

No history of fever, chest pain, palpitations

Patient is on 
RESP. Ipratropium bromide + levosalbutamol 200 MDI TID
T. Theophyline + Etopylline 23/77 mg PO BD
T. MONTEC -LC 10/5 mg PO OD
Since 10 days

Past history
Not a known case of diabetes mellitus, hypertension, tuberculosis, epilepsy

Patient has H/O ?CSOM  at 5 yr age and developed rt sided hearing loss
VITALS
TEMPERATURE - 99.1
PULSE RATE - 87 BPM
BLOOD PRESSURE - 220/110 MM OF HG 
RESPIRATORY RATE - 30
SPO2 - 97 % AT ROOM AIR

General examination
Patient is conscious coherent cooperative well oriented to time place and person
Pallor +
No Ictrus, cyanosis, clubbing, lymphoadenopathy

SYSTEMIC EXAMINATION - 
PER ABDOMEN : DISTENDED, unblicus inverted SOFT, TENDER in Rt iliac fossa, Rt lumbar, rt HYPOCHONDRIUM
CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
RESPIRATORY SYSTEM : 
BILATERAL AIR ENTRY PRESENT, decreased breath sounds - Wheeze present in Rt>Lt IAA, IMA, ISA
CENTRAL NERVOUS SYSTEM : NAD








Ultrasound
Rt kidney - 6.4*3 cm CMD lost, PCS NORMAL
Rt kidney - 5.7*2.9 cm CMD lost, PCS NORMAL

Chest X-ray


Diagnosis
Chronic kidney disease with A/E of COPD WITH metabolic acidodis, and hypertensive emergency

Treatment
Fluid restriction <1.5 l/day
Salt restriction <2g/day
Inj. Lasix 40mg IV BD
T. Nodosis 500mg BD
T. Bio-D3 0.5 mg OD
T. OROFER - XT PO OD
NEB. DOULIN 6TH HRLY
NEB. BUDICORT 8TH HRLY
INJ. ERYTHROPOIETIN 4000 IU SC WEEKLY

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