57 yr male pt with generalized swelling in legs
57 year old man with generalized swelling in his legs since 10 days
A 57 year old man, who works different jobs for wages, hailing from Miryalaguda presented to the hospital with-
• generalized swelling of legs since 2 days.
Date of admission - 7/10/21.
HISTORY OF PRESENT ILLNESS
• The patient was apparently asymptomatic two years back.
• Patient noticed swelling in their legs one and a half year ago.
• They visited a hospital in Miryalaguda who diagnosed the patient with Chronic Kidney Disease.
• The hospital instructed the patient to start dialysis.
• The patient starts dialysis but the pandemic ensues leaving patient and their family in financial weeds.
• In mid 2020 the patient decides to stop going for dialysis for 8 months.
• At home, the patient usually wakes up by 7am. They do not work or participate in the household activities.
• The patient then sits out of the house in the sun till lunch.
• After lunch patient sleeps; to wake up after 2 hours.
• The patient then gathers with their friends and talks to them till it's time for dinner.
• They complete their final meal of the day and then goes to bed.
• One fine afternoon, the patient notices their legs swelling up and his urine output decreasing drastically at the same time.
• Then, the patient came forward to this current hospital and admitted himself 8 months ago.
• They have been on dialysis ever since.
PAST HISTORY
• The patient suffers from Diabetes Mellitus.
• The patient suffers from Hypertension.
• Both Diabetes Mellitus and Hypertension were apparently diagnosed three or four years back, from the time he had the first symptom of CKD.
• The patient doesn't suffer from Tuberculosis.
• The patient also doesn't suffer from asthma and epilepsy.
• They were never involved in any kinds of accidents.
• They have never undergone any surgeries.
• The patient recollects that he had undergone two blood transfusions about a month ago.
PERSONAL HISTORY
• The patient consumes a mixed diet of vegetarian and non vegetarian food.
• The patient was strictly consuming vegetarian diet since the symptoms of CKD appeared 8 months back.
• They are of mesomorphic built.
• They appear to be adequately nourished. .
• There was a gradual onset of reduced micturition.
• Bowel movement is normal.
• They apparently have no habit of smoking.
• They apparently have no habit of drinking.
FAMILY HISTORY
• No one in her family complains of a similar problem with similar presentation.
• No one in their family suffers from any genetic conditions or deformities.
• As far as the patient knows, all the deaths in their family were by natural causes.
ALLERGY HISTORY
• Patient is not allergic to any known drug or food.
• There is no known allergy to dust or pollen in the patient.
DRUG HISTORY
• On equiry, the patient refused to have taken any sorts of steroids, oral diabetes, insulin, ANTIHYPERTENSIVES, diuretics, ergot derivatives, monoamine oxidase inhibitors, hormone replacement therapy or contraceptive pills — prior to coming to the hospital.
GENERAL EXAMINATION
• The patient is concious, coherent and cooperative.
• On examination, patient's mood appears to be well.
• Their built is mesomorphic.
• The patient has oedematous face.
• There is no lymphadenopathy present.
• There is no presence of clubbing.
• The patient has icterus.
• The patient has scratch marks over their legs confirming pruritis.
• There is oedema in both of their legs - pitting type.
• No decubitus is present.
• Patient has substantial pallor and pale tongue; appears to be anemic.
• Patient appears to be mildly dehydrated.
• Vitals (on examining)
Temperature- 99.3°F
Pulse Rate- 81bpm.
S1 and S2 are heard.
spO2- 97.
Blood Pressure is 143/90.
PROVISIONAL DIAGNOSIS
(?) Chronic Renal Failure secondary to neglected Hypertension.
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