56 male with c/o bilateral pedal edema
Patient with
c/o bilateral pedal edema since 1 month ,
C/o fever and burning micturition since 20 days
HOPI
Pt was apparently asymptomatic 1 month ago back and then had complaints of b/l pedal edema pitting type followed by complaints of fewer low grade intermittent associated with burning micturition since 20 days
No c/o loin pain ,hematuria, decreased urine output
H/o NSAID abuse since 20 days
K/c/o CKD 3 yrs
H/o CVS 6 YRS AGO
N/k/c/o DM ,TB, EPILEPSY ,HTN ,CAD
General examination
No pallor,icterus,cynosis,clubbing, lymphadenopathy.
B/l ,pedal edema pitting type
Vitals
BP 110/60 mm hg
PR 88 bpm
RR 25 cpm
Temp 100.6 °F
Systemic examination
RS-B/L air entry present
NVBS
CVS- S1s2present, no murmurs heard
PA- soft and non tender.
CNS - no focal neurological deficits
Diagnosis
CKD on MHD
Septic shock
Investigation
22/5/23
Anti hcv -non reactive
Hbs ag - negative
Hiv 1/2 rapid test - non reactive
Serum iron 75 ug/dl
Usg report
Grade 3 rpd changes
On 29/5
On 2/6
On 3/6
On5/6
Treatment
On 2/6
Salt restriction < 2g/dl
Fluid restriction < 1.5 l/day
Inj erythropoietin 400 IU /IC / once a week
Tab lasix 40 mg po tid
Tab nodosis 500 mg po bd
Tab shelcal 500 mg po od
Tab orofer xt po od
Cap bio d3 po / weekly once
On 3/6
Salt restriction < 2g/dl
Fluid restriction < 1.5 l/day
Inj erythropoietin 400 IU /IC / once a week
Tab lasix 40 mg po tid
Tab nodosis 500 mg po bd
Tab shelcal 500 mg po od
Tab orofer xt po od
Cap bio d3 po / weekly once
Tab pcm 650 mg po tid
Inj NORAD 5 ml/ hr to maintain acc to MAP > 65
Inj vancomycin iv / stat
On 4/6
Salt restriction < 2g/dl
Fluid restriction < 1.5 l/day
Inj erythropoietin 400 IU /IC / once a week
Tab lasix 40 mg po tid
Tab nodosis 500 mg po bd
Tab shelcal 500 mg po od
Tab orofer xt po od
Cap bio d3 po / weekly once
Inj meropenem 1g iv /stat
Inj NORAD ds 4 ml +46 ml NS @ 4.5 ml/hr to maintain MAP >65 mm hg
Inj meropenem 500 mg iv bd
On 5/6
Salt restriction < 2g/dl
Fluid restriction < 1.5 l/day
Inj erythropoietin 400 IU /IC / once a week
Tab lasix 40 mg po tid
Tab nodosis 500 mg po bd
Tab shelcal 500 mg po od
Tab orofer xt po od
Cap bio d3 po / weekly once
Inj NORAD ds 4 ml +46 ml NS @ 4.5 ml/hr to maintain MAP >65 mm hg
Inj meropenem 500 mg iv bd