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
blood group O positive
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
On 6/6



On 7/6

at 6:30 am
at 6:30 pm 

At 8:30 pm


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 


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