62yr old with pedal edema and fever

A 62 year old male came to the OPD with chief complaints of:-

Pedal edema since 1 month
Decreased urine output since 1 month
Fever since 2 days


HOPI :-

Patient was apparently asymptomatic 3 years back then developed pedal edema, shortness of breath, fever, cough and was admitted in a private hospital hyd and diagnosed as renal failure.

In February/march 2022 patient came to kamineni Narketpalli with chief complaints of shortness of breath and decreased appetite and undergone dialysis under 3 sessions and was on conservative management.

In November 2022, patient came with similar complaints and undergone dialysis here

Now he developed pedal edema since 1 month which is pitting type and complained of fever since 2 days which is continuous ,high grade and associated with chills and rigor.

H/o nausea, vomiting, anorexia 04jan night.

Vomiting is non projectile, non bilious, non blood tinged contained food particles associated with nausea in 2-3 episodes.

No h/o burning micturition, pain abdomen.

H/o abscess over left medial and infra gluteal region 1 year back.

Came for dialysis ( no regular follow up)


Past history :- 

K/C/O Diabetes  since 3 years
K/c/o hypertension since 6 years

Patient had a history of knee injury 3 years back for which he undergone surgery.

N/K/C/O  CAD, epilepsy, asthma, Tuberculosis



Personal history :-

Diet - mixed
Appetite - decreased 
Sleep - adequate
Bowel - regular
Bladder - decreased urine output
Addictions No ( toddy occasionally)


Family history :-
No similar complaints



General examination:-
Patient was conscious, coherent, cooperative 
Well oriented to time, place and person

Pallor +
Icterus cyanosis clubbing lymphadenopathy absent
Edema +












VITALS:-

Temperature :  febrile ( 102F)
PR : 84 bpm
BP : 110/70 mmHg
RR : 14cpm


Systemic examination :-

Respiratory system:-

Trachea central
B/L airway entry +
NVBS heard

CVS :-

S1, S2 heard
No murmurs heard


Per abdomen:-

Soft, non tender, bowel sounds heard

CNS :-

No focal neurological deficits


Provisional diagnosis :-

—CKD with MHD
Secondary to Diabetic nephropathy
(K/C/O DM since 3 years)
—Anemia secondary to CKD
—Pyrexia under evaluation



Investigations :-



























































  




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