A 60 yr old MAN WITH CHRONIC RENAL FAILURE WITH BLINDNESS UNDER EVALUATION .

A 60 yr old male , driver by occupation , came with complaints of
1) Facial puffiness and vomitings since 5 days 
2) B/l pedal edema ( pitting ) since 4 days

HOPI :- 
0He was apparently asymptomatic 10 yrs ago , then he developed blurring of vision for which he went local hospital and was diagnosed  with Hypertension and diabetes mellitus type 2 and started on treatment (irregular).

3 MONTHS BACK ,he complaints of vomitings -5 episodes ( food particles as content) ,non bilious ,non projectile, so he went to a local hospital in khammam and was told to have kidney infection and took medication for 1 week .

AT PRESENT , he complaints of increased urine Nocturia since 6 days ,
Facial puffiness since 5 days and 
B/l pedal edema (pitting type) since 4 days
Loss of appetite+
Dull with slow speech since 1 week
SOB (grade2)  ,with cough on walking for a short while.

PAST HISTORY:- 
 K/c/o T2DM and HTN since 10 years on irregular medication.

Visual acuity--
Right eye -- complete blind
Left eye-- Hand movements+

Personal History:-
Appetite- decreased
Diet- mixed
Bowel movement- Regular
Alcoholic +
Non smoker


On examination:

Pt is C/c/c

No Pallor,Icterus,Cyanosis, clubbing,Lymphadenopathy

B/L pedal Edema(pitting type) present

VITALS ON ADMISSION:- 
TEMPERATURE- Afebrile
BP:- 190/110 mmHg
PR-- 91 BPM
RR- 21 cpm
Spo2:- 97% on RA

Systemic examination:- 
PER ABDOMEN: soft, non tender
CVS: S1S2 heard
RS: BAE +, NVBS+
CNS: NAD 




DIAGNOSIS:- 
CHRONIC RENAL FAILURE WITH BLINDNESS UNDER EVALUATION.

TREATMENT:-
ONE HEMODIALYSIS DONE ON 19/01/22

1) INJ. LASIX 40 MG IV /BD
2) Tab. NICARDIA 10MG PO/BD
3) INJ. HAI ACCORDING TO SLIDING SCALE.
4) TAB. NODOSIS 550 MG PO/BD
5) TAB.SHELCAL PO/OD
6) INJ. ZOFER 4 MG IV /OD
7) INJ. PAN 40 MG/IV/OD
8) INJ. PIPTAZ 2.25 GM IV /TID
9) MONITOR VITALS AND INFORM SOS.



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