70M CKD Sec to RVD


THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT 
A 70 year old Male Who was a Farmer by Occupation  came to OPD with C/O 
B/L Knee Pains & LBA Since 10 days
SOB ; B/L Pedal Edema Since 1 Week 
Vomitings Since 3 days 
HISTORY OF PRESENTING ILLNESS:

Pt Was Apparently Asymptomatic 20 years back and developed Fever for which he went to Hospital and Informed that he has ? Renal Problem for which he Used Some ? Medication for 1 Year & Then He was Fine.5 years Back he was Diagnosed with RVD & Started Using ART. Then He was Fine & 10 Days Back he Started Having B/L Knee Joint Pains & LBA for which He used NSAIDS for 30 days. 1 Week Back He Started having SOB ( Grade 2 ) ; Low Grade Fever - Not Associated with Chills & Rigors / Body Pains ; 3 Days Back he started having Vomitings - 1 Episode / Day , Non Projectile, Non Bilious,containing Food Particles , Non Blood Tinged.
12  years back his wife was Diagnosed with RVD & 6 years back he was Diagnosed with RVD 
Past History : 
H/O RVD + Since 6 Years & on Medication
N/K/C/O HTN DM TB EPILEPSY ASTHAMA CAD 

PERSONAL HISTORY :

DIET - MIXED,
APPETITE -DECREASED,
BOWEL MOVEMENT - REGULAR , 
BLADDER MOVEMENTS - REGULAR, ADDICTIONS(ALCOHOL AND SMOKING ) - chronic Smoker & Alcoholic since 30 years


ON EXAMINATION -

PATIENT IS CONCIOUS , COHERENT COOPERATIVE
No ICTRUS
No PALLOR
No CLUBBING , CYANOSIS , LYMPHADENOPATHY
Mild B/L Pedal Edema + 

VITALS - 

TEMPERATURE - 97' F
PULSE RATE - 90 BPM
BLOOD PRESSURE - 90/60 MM OF HG 
RESPIRATORY RATE - 20
SPO2 - 98 % AT ROOM AIR

SYSTEMIC EXAMINATION - 

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS
RESPIRATORY SYSTEM : BILATERAL AIR ENTRY PRESENT ,NORMAL VESICULAR BREATH SOUNDS
CENTRAL NERVOUS SYSTEM : NFND
P/A - NO TENDERNESS & NO ORGANOMEGALY
Investigations :
TREATMENT GIVEN :

ORAL SALT RICH DIET & FLUIDS
IVF - 2 NS @30ML/HR + Urine Output / HR 
TAB.SHELCAL 500MG PO OD
CAP.BIO D3 PO OD
TAB.ULTRACET 1/2 tablet PO QID
TAB.TENOFOVIR(300MG) LAMIVUDINE (300MG ) DOLUTEGRAVIR (50MG) PO HS
SYP POTCHLOR 10ML IN 1GLASS OF WATER PO TID

Discharge Summary : 
Brief Course In the Hospital : 
A 70 year old Male Who was a Farmer by Occupation  came to OPD with C/O 
B/L Knee Pains & LBA Since 10 days
SOB ; B/L Pedal Edema Since 1 Week 
Vomitings Since 3 days & on Further Evaluation diagnosed as HYPOTONIC HYPONATREMIA ( ? HYPOVOLEMIC ?SIADH ) HYPOKALEMIA WITH AKI ON CKD WITH RVD +VE SINCE 5 YEARS WITH COPD & OSTEOARTHRITIS KNEE and Treated accordingly
Vitals at the Time of Discharge :
BP - 80/50 in Supine & standing posture
PR - 92BPM
CVS - S1S2 + & No MURMURS
RS - BAE+ ; NO ADDED SOUNDS
P/A - SOFT ; NON TENDER
CNS - NFND

ADVISE AT DISCHARGE : 
TAB.ULTRACET 1/2 TAB PO QID 
SYP. POTCHLOR 15ML IN 1 GLASS OF WATER PO TID

Review : 
Review after 3 days to GENERAL MEDICINE OPD with CD4 Counts

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