70 YEAR OLD MALE WITH ACUTE ON CHRONIC RENAL FAILURE( SEPSIS INDUCED) ANALGESIC NEPHROPATHY

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A 70 year old male patient came to the casualty with c/o pedal edema since 1 n half month which is progressive,pitting type, bilateral associated with facial puffiness.

No h/o SOB, Oliguria, abdominal distension.

pt complains he has HICCUPS since 15days.

C/O Vomiting 10days back,food particles as content,non projectile,bilious.

He usually have episode of vomiting when he is traveling on bike or any other mode of transport.

H/OB/L pedal edema 2yrs back, used medication for it and the edema subsided.

Pt is k/c/o HTN since 1 and half year. 

Not a k/c/I DM,CAD,ASTHMA,TB.

Appetite - normal

Diet - mixed

Bowel movements- regular

Micturition- urinary hesitancy +dribbling of urine+no increased frequency of urine

Sleep- adequate

Habits- Alcohol -90ml occasionally

Tobacco- 1 chutta/day, stopped since 3 yrs.

No significant family history.

O/E

Edema of feet -B/L grade 2 pitting type

Temp-afebrile

PR-78bpm

RR-23cpm

BP-200/100mm Hg

Spo2-. 98%on RA

SYSTEMIC EXAMINATION-

CVS- S1 S2 heard, no murmurs

RS- decreased air entry on left 

ISA,IAA.

P/A- soft, non tender.

CNS-conscious,speech - normal, no signs of meningeal irritation.NAD.

PROVISIONAL DIAGNOSIS

?CCF/? RENAL FAILURE.

TREATMENT GIVEN:-

Inj.LASIX 40mg/iv/ stat.

Bp charting 6 th hourly.

INVESTIGATIONS:-

ECG

CHEST X RAY PA VIEW:-

2 D ECHO

USG ABDOMEN

ABG

CUE:-

Albumin :+++

Sugar - nil

Pus cells  4 to 5

Epithelial cell :- 3 to 4

Plan of care

Fluid restriction <1.5l/day

Salt restriction <2g/ day

Inj.LASIX 40 mg  IV/BD

Inj.NEOMOL IV SOS  ( temp 101F)

Tab. PCM 650 MG PO SOS

TAB.AMLONG 5 MG PO/OD 

TAB. METXL 25 mg PO/OD

Bp charting 4 th hrly

I/O charting

Temp charting 6 th hrly