55 yr old male with bilateral pedal edema

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55 year old male patient farmer by occupation came with chief complaints of Bilateral pitting type of edema since one and half month and Grade 2 shortness of breath since 1and half month.

HOPI:

Patient was apparently asymptomatic 1 and half month back then he had trauma to left lower limb for which he went to local hospital and used some antibiotics .Then he started developing bilateral pedal edema pitting type which was below knees and now progressed to above knees.Then he developed shortness of breath grade 2.Edema of left upper limb seen for which he went to NIMS hospital and undergone 6 sessions.There he diagnosed with HTN  and he is on ARKAMIN 0.1mg BD

No h/o cough,burning micturition,orthopnea

Past history-

Known case of hypertension since 1 and hf month

Not a k/c/o diabetes,thyroid abnormalities,asthma, tuberculosis , epilepsy.

Family history - not significant

Surgical history -underwent a surgery for brain clot 15 years ago

Personal history -

Diet- mixed

Appetite -decreased

Bowel and bladder movements- regular

Sleep - inadequate

addictions-chronic alcoholic since 30 years

No h/o allergies

General examination-

Patient is conscious, coherent, coperative ,well oriented to time ,place ,person 

Malnourished 

O/E:

Temp- afebrile to touch   

BP-160/100mmhg

Pr-17/min                             

Spo2-98% 

Rr-20/min      

Palor- present 

No- icterus, cyanosis, lymphadenopathy

B/l-pedal edema present 

Systemic examination:

Cvs-s1,S2 heard,no mumers

Respiratory system-Dyspnoea -present

                                  Trachea-central in position

Vesicular breath sounds -heard 

Abdomen-soft ,non tender

Cns-No focal deficits

                    Investigations:

  Complete blood picture:

complete urine examination:

doppler:

USG:

ECG:

PRIVISIONAL DIAGNOSIS:

  CHRONIC RENAL FAILURE

TREATMENT:

1.Fluid and salt restriction

2.T.Arkamin 0.1mg 

3.Tab Nodosis 500mg

4.Tab shelcal 500mg

5.Tab Lasix 40mg

6.Hemodialysis