65 yrs old male patient came to casualty with complaints of no urine output and shortness of breath

 

GENERAL MEDICINE CASE

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Patient came with cheif complaints of decreased urine output since 1 week and complete stoppage since yesterday and bilateral lower limb swelling and cough with sputum.

Patient was apparently asymptomatic 1 week back and then he developed decreased urine output since 2 days and no urine output since 2 days and shortness of breath since 3days and pedal edema since 1 week. 

Past history:-Patient had H/o of CKD since 2 year and H/o 3 dialysis sessions done in 2020 followed by since then on medical management.

H/o COPD  since 3 years.

O/E:- pt is c/c/c.

BP-90/60 mmHg

PR- 80 bpm

RR- 22cpm

Spo2-98%on 6L o2.

CVS-S1S2 +

RS- BAE+

CNS- NAD.

P/A - soft ,non tender

Investigations:-

Provisional diagnosis:-

Chronic kidney disease with COPD.

Treatment:-

Inj lasix 20 mg IV BD.

Inj NORAD 20ml/hr 

Inj Dobutamine 7.2ml/hr

IV fluids NS @ uo+ 50ml/hr.

Nebulization with Ipravent and budecort.

Inj optineuron 1amp  in 100 ml NS IV OD.

Tab pulmoclear 100mg po  BD

Tab orofer XT po OD

 

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