47 yr male with ? CKD ( Diabetic Nephropathy) , ? Heart Failure

47 year old male ,auto driver by occupation , came to the OPD with the chief complaint of

Pedal edema , Facial puffiness since 6 days

Shortness of breath since 6days , Increased since past 3 days

Decreased urine output since 3 days

History of Presenting illness - 

Patient was apparently asymptomatic 8 years ago

8 years ago - During a regular checkup he was found to be Hypertensive

6 years ago -  He had complaints of generalized weakness and weight loss 

He was diagnosed to be diabetic

5 years ago - He was diagnosed with Acute pancreatitis

6 days back - Pt developed pedal edema, progressed gradually to knees along with Facial puffiness

Decreased urine output since 6d 

Shortness of breath since 6d 

Grade II-III progressed to Grade IV since 3 days along with orthopnea and PND 

Decreased appetite

No c/o chest pain, palpitations, giddiness ,fever, cold, cough, burning micturition

PAST HISTORY -

Known case of Hypertension since 8years on Tab Olmesartan 20mg OD

Diabetes mellitus since 6 yrs on Tab Glimy M2 OD

H/O Acute Pancreatitis 5 yrs ago

Not K/C/O TB, Epilepsy, Asthma, CAD.

Personal history

Appetite- Decreased

Bowel movement- Regular

Alcoholic stopped 5 yrs ago

Smoking stopped 5 yrs ago

On examination

Pt is C/c/c

No Pallor , Icterus ,Cyanosis, Clubbing,Lymphadenopathy

Edema of feet + 

Vitals

Pr:94bpm

Bp:180/100

Spo2:97% at RA

Temp - Afebrile

Grbs - 166 mg/dl

Systemic examination

CVS - S1,S2 +

RS - BAE + B/L ISA, IAA crepts +

CNS - NAD

Investigations

Serology - Negative

RBS - 105mg/dl

Provisional Diagnosis - ? Heart Failure

? CKD ( Diabetic Nephropathy) 

Treatment

Fluid restriction (<1l/day)

Salt restriction (<2g/day)

Inj· LASIX 40 mg IV TID, if Sbp > 100 mmhg.

Inj. Pantop 40 mg IV/BD.

Inj. Actrapid + NPH s/c acc to GRBS

Tab. CARDACE 2.5mg - PO/BD

Tab. CARVEDIOL 3.125mg PO/OD.

Tab. ECOSPIRIN - 75mg PO/OD .

Tab. ATORVAS -10 mg HS.

O2 Inhalation SOS.

BP/PR charting 2nd hourly.

GRBS charting 6th hourly

Strict I/O charting.

Daily weight monitoring.

CLINICAL IMAGES

INVESTIGATIONS