1601006143 short case

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 A 52 year old male farmer my occupation presented to the opd with chief complaint of bilateral swelling in lower limbs since 3 days

History of presenting illness:

The patient was apparently asymptomatic 1 week back then he developed bilateral swelling over legs since 1 week, which started near the foot and gradually progressed to the knee. It was pitting type which resolved in between and again started 3 days back.

He had similar complaints in the past for which he went to a local hospital and was advised on taking salt and water restricted diet.

Patient on telmesartan for hypertension since 2 years.

He is a chronic alcoholic and smoker.

Examination :

Bilateral pedal edema pitting type of grade 3 found till knee on general examination.

Respiratory system : Bilateral air entry present and normal vesicular breath sounds heard.

CVS examination : No thrills, s1 s2 heard, no murmurs.

Abdomen examination : no hepatomegaly or splenomegaly.

Investigations :

RFT

Hemogram 

LFT 

PROVISIONAL DIAGNOSIS :

Chronic renal failure

TREATMENT :

Salt and fluid restriction (<1gm/day <1 lit/day)

Inj. Lasix 40mg

Tab. Nicardia 10 mg TID

Inj. Erythropoietin

Tab. Shelcal