60 yr old male with HTN urgency


60 year old male Pt came with the complaints of 
abdominal distension since 15 days swelling of both lower limbs, upperlimbs 
facial puffiness since 4 days 
 difficulty in breathing since 2-3 days

HOPI:
Patient was apparently alright 15 days back when he developed abdominal distension which developed gradually a/w b/l pedal edema, pitting type (R>L) , upper limbs edema and facial puffiness . Since 2-3 days he has SOB which is of grade II/ III 
No h/o fever, decreased urine output, heamaturia and frothy urine
No h/o chest pain/palpitations/giddiness/ neck pain 
H/o CVA (right hemiparesis resolved now) 11 years back when he was also diagnosed with hypertension 
H/o hypertension since 11 years on telmibind amh po/od
H/o diabetes since 5 years on glimi m2 po/bd
H/o right lower limb cellulitis 7 years back
H/o ?right lower limb filariasis

Personal history:
Sleep-normal
Appetite-normal
Bowel and bladder movements-normal

Addictions:
Alcohol: occassionally
Tobacco smoking: smoker 4 yrs back stopped now

General examination:

Vitals at presentation
Bp 200/100
PR 90bpm
Grbs 52mg/dl
RR 18cpm
Pt has
No pallor
No icterus
No cyanosis
No clubbing
No lymphadenopathy
Pedal oedema+ pitting type grade-3 

CVS examination:
S1S2 +NO MURMURS 

Respiratory examination :
BAE +, NVBS 

Per abdomen examination 
abdomen distended,
Soft, non tender, bowel sounds present
Fluid thrill- , shifting dullness -

CNS-
NFND

INVESTIGATIONS:
On 27/11/22
Diagnosis:
HTN urgency
CKD(?DIABETIC NEPHROPATHY,CUE-alb+,creat-3)
DM with OHA induced hypoglycemia 
HEART FAILURE WITH PRESERVED EJECTION FRACTION(chambers dilated with concentric LVH On echo)

Treatment:
Day-1:
1)INJ LASIX 40mg / IV/ TID
2) TAB. CILNIDIPINE 10MG / PO/ BD
3) TAB.MET - XL 25 mG | PO / OD
4)TAB ECOSPIRIN AV PO /OD
4)TEMP, GRBS, PR, BP, RR CHARTING 2nd hrly

Day-3:
AMC BED 4
DAY-3
28/11/22

S:
No stools passed 
No fever spikes

O
Pt is C/C/C
BP:150/100mmHg
PR:90bpm
Temp : 98.6F
GRBS : 121mg/dl
CVS:S1S2 +NO MURMURS 
RS :BAE +, NVBS 
CNS-NFD
P/A:SOFT,NT
I/O - 1400/1500mL

A
HTN urgency
CKD(?DIABETIC NEPHROPATHY,CUE-alb+,creat-3)
DM with OHA induced hypoglycemia 
HEART FAILURE WITH PRESERVED EJECTION FRACTION(chambers dilated with concentric LVH On echo)

P

1)INJ LASIX 40mg / IV/ TID
2)INJ.LABETALOL 10mg/IV/SOS
3) TAB.MET - XL 25 mG | PO / OD
4)TAB ECOSPIRIN AV PO /OD
5)TAB.ARKAMINE 0.1mg PO/TID

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