65 year old female with diabetic nephropathy
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CASE:
A 65 year old female came with chief comlaints of pedal oedema and shortness of breath from 9 days
History of present illness:
-The patient was apparently asymptomatic 9 days ago then she developed swelling of lower limbs,which was insidious in onset ,gradual in progression and extending upto knee
-Shortness of breath from 9 days, which has increased from grade 2 to grade4
-she has easy fatigability and unable to walk
-she had swelling of hands and legs and puffiness of face from 3 days
-She is unconscious, altered sensorium from 2days
Past history:
-She is a known case of diabetes and hypertension from last 13 years and is on medication
-She had a fall 3 months ago due to which she had fracture of wrist
- No history of asthma , tuberculosis, epilepsy
Present history:
Appetite -normal
Diet-mixed
Bowel and bladder movements- constipation, decreased urine output
Sleep -Adequate
No addiction
Family history:
-Her younger brother has diabetes
General examination:
-patient is unconscious
-Pallor is present,pitting type of pedal edema is
-No icterus,cyanosis-, clubbing, generalized lymphadenopathy
Vitals
Temperature :Afebrile
Pulse rate:91 bpm
Blood pressure:140/90 mm of Hg
Respiratory rate:34cpm
Systemic examination:
CVS:S1,S2 heard,no murmurs
Respiratory examination:
Inspection:
Chest shape is elliptical
Bilateral symmetry of chest
Exapands equally on inspiration
Rate and rhythm:34cpm
Trachea: central
No dilated veins and scars and sinuses
On palpation:
Position of trachea central
Apex beat : 6 th left ics
Equal expansion of chest on respiration.
No tenderness over chest
On percussion:
Dull note in infraxillary,mammary, infrascapular.
Resonant node heard
On Auscultation:
Normal Vesicular breath sounds
B/L Basal crepts in infra axillary, mammary, infrascapular.
Abdomen :soft and non tender
CNS:GCS-E1M1V1
Investigation:
Blood urea-154mg/dl-Elevated
RBS-180mg/dl-Elevated
USG-B/L Grade1 RPD
30/03/22
31/03/22
ST depression in lead 2,V5, V6, avf,avr
Treatment:
On 29/03/22,30/03/22,31/03/22
1) TAB . Lasix 40 mg PO/BD
2) TAB. Nodosis 500 mg PO/BD
3) TAB. Shelcal CT 500 mg PO / OD
4) TAB. Orofer XT 1 tab PO /OD
5) TAB. PAN 40 mg PO/OD
6) INJ. Erythropoietin 4000 IU SC. Weekly once
7) TAB. Nicardia 20 MG PO/TID
Provisional diagnosis:
Chronic kidney disease stage5 due to diabetic nephropathy
On 31/03/22
9.00Am:Patients was gasping for air, and was hypotensive B. P 60/40.Pulse feeble..
Incubation Done. B.P was 90/40. Ecg showed ST depression in lead 2,V5, V6, avf
avr
Time of Death:11.07am
Most probable cause of death :N STEMI
Posterior wall MI