58 yr old man

 58 year old man from mandepally presented with c/o B/L pedal edema since 3 months ,abdominal distention since 2 months ,facial puffiness since 2 months dyspnea on exertion since 1 month,frothy urine since 1 month ,cough with expectoration since 5 days and fever since 1 day 

Patient works as a farmer at mandepally and has been having B/L knee joint pains since 5 months for which he has been taking medications and B/L pedal edema extending upto knees since 3 months followed by abdominal distention and then facial puffiness and the dyspnea on exertion and also frothy urine since 1 month 

He has been complaining of cough with mild sputum expectoration associated with hemoptysis, non foul smelling and high grade  fever since 1 day 

No c/o hematuria,loin pain, pain abdomen, reduced urine output

No c/o chest pain,palpitations, dizziness, sweating 

He is alcoholic since 20 years 90 ml whiskey 3 times a week his last intake was 1 year back

O/E patient is conscious, coherent and cooperative 

Vitals 

Temperature:101 F

Pulse rate: 77 bpm

RR:24 cpm

BP: 130/70 mmhg

S/E 

Cvs: S1S2 heard 

Apex beat in 5th intercoastal space at midclavicular line 

RS: B/L inspiratory crepts in infraxillary area, and inframammary area, infrascapular area 

P/A :soft and non tender 

CNS: intact ,no focal deficits 

Investigations 

CBP

Hb:12.9 gm/do

TLC: 8800 cells/cumm

Plc: 1.85 lkhs/cumm

CUE

Albumin : nil

Sugar : nil

Pus cells: 4-5

Rbc: nil

Epithelial cells: 2-4

RFT

Urea: 45 mg/dl

Creatinine: 1.5 mg/dl

Uric acid : 6.3 mg/dl

Ph :2.3 mg/dl

K:3.4 meq/l

LFT

Tb: 0.94 mg/dl

Db: 0.18 mg/dl

AST: 34 IU/L

ALT:27 IU/L

ALP:104 IU/L

TP: 5.3 gm/dl

Albumin :3.1 gm/dl

Urine spot protein creatinine ratio 0.12

Urinary electrolytes

Na+ 218 mmol/L

k+ 10.8 mmol/L

cl- 128 mmol/L

                            Ecg


                 Chest X ray P/A view



Treatment 

Fluid restriction less than 1.5L/day

Salt restriction less than 2 gm/day

Inj Lasix 40 mg IV /BD

Inj Augmentin 1.2 gm IV/TID

Syrup Ascoril 10 ml /PO/TID with 1 glass of water

Tab Dolo 650 mg /PO/SOS

Temperature charting 

Inj Neomol 100 ml /IV SOS if temp greater than 102F

Inj Thiamine 1 amp in 100 ml NS/IV/BD










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