VANDANA's blog

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:
An 60 year old female farmer by occupation from timmapuram who was apparently alright 3 years back when she developed giddiness during her daily activities for which she went to a local hospital where she was diagnosed with hypertension and is using medication.
1 year later while she was going to bathroom she fell down due to giddiness and had a fracture to her left femur for which she underwent a surgery in NIMS. 
At that time during routine investigations  she was diagnosed with kidney failure and medical management was tried. 
1 year later in november 2019 she developed pedal edema for which she was taken to a hospital in khammam where she was diagnosed with CKD and is put on medical management.
1 week later she had increased SOB, anasarca and intermittent palpitations for which she was taken to a hospital in suryapet where they told her the need for dialysis and referred her to hyderabad.
After undergoing dialysis (2/week) for nearly 1 month in hyderabad she came to our hospital for MHD and from then she was on MHD in our hospital (2/week).
15 days back she had a history of trauma and 5 days later she had swelling of left leg upto mid calf associated with pain and fever (cellulitis) for which fasciotomy was done on 4/12/2020.
Later on 6/12/2020 during dialysis she developed giddiness due to hypotension & hypoglycemia and was shifted to ICU and recovered with medical management.

No h/o chest pain, orthopnoea, PND
No h/o pain abdomen, vomitings, loose stools 
No h/o headache, involuntary movements, LOC
No other complaints.

PAST HISTORY:
K/c/o HTN from 3 yrs and is on treatment
Not a k/c/o DM , Asthma , Epilepsy , CAD , TB.

PERSONAL HISTORY:
Normal appetite 
Mixed diet
Adequate sleep
No addictions

GENERAL EXAMINATION:
Pt c/c/c
Pedal edema present 
Tenderness and local rise of temperature present over left foot
No pallor, icterus, cyanosis, clubbing,  koilonychia, lymphadenopathy.
PR: 92 bpm
BP: 130/80 mmhg
SYSTEMIC EXAMINATION:
CVS : Apex beat + in 6th intercostal space lateral to MCL
 S1 S2 + , No murmers
RS : BAE + , NVBS
P/A : SOFT,  NT
CNS : NFND

INVESTIGATIONS:

17/11/2020


1/12/2020

2/12/2020

3/12/2020

4/12/2020

5/12/2020

7/12/2020

8/12/2020

9/12/2020

10/12/2020


11/12/2020



DIAGNOSIS:

CKD on MHD with HFpEF (CRS - 4)
LEFT FOOT CELLULITIS

TREATMENT: MHD

1.Inj magnet forte 1.5g iv BD
2.Inj metrogyl 500mg iv TID
3.Tab lasix 40mg Po BD
4.Tab pan 40mg OD 
5.Tab orofer xt po OD 
6.Tab shelcal CT  po BD
7.Tab chymerol forte po TID
8.Tab neomol 1g iv stat 
9.Neb with asthalin 8th hrly 
                  Mucomist /budecort /12th hrly
10.Mgso4 dressing and foot end elevation 
11.Syp grillinctus 10ml TID
12.Syp cremaffin plus 10ml TID

DISCUSSION:

RENOCARDIAC SYNDROME:

INTRADIALYTIC HYPOTENSION:

INTRADIALYTIC HYPOGLYCEMIA:

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