A 80/M with CKD with A/E of COPD CBBLE UDHC similar cases

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Chief complaints

Came to casual the with complaints progression of shortness of breath (grade 2 since 10 days, grade 5)

History of presenting Illness 

Patient was apparently asymptomatic 10 days back then he had insidious onset shortness of breath grade 2 not associated with any orthopnea and pnd relieved on taking bronchodilators and exacerbated to sudden oncet grade 4 (stopped taking bronchodilators 2 days back)

H/O pedal edema on - off since 4mo

No history of fever, chest pain, palpitations

Patient is on 

RESP. Ipratropium bromide + levosalbutamol 200 MDI TID

T. Theophyline + Etopylline 23/77 mg PO BD

T. MONTEC -LC 10/5 mg PO OD

Since 10 days

Past history

Not a known case of diabetes mellitus, hypertension, tuberculosis, epilepsy

Patient has H/O ?CSOM  at 5 yr age and developed rt sided hearing loss

VITALS

TEMPERATURE - 99.1

PULSE RATE - 87 BPM

BLOOD PRESSURE - 220/110 MM OF HG 

RESPIRATORY RATE - 30

SPO2 - 97 % AT ROOM AIR

General examination

Patient is conscious coherent cooperative well oriented to time place and person

Pallor +

No Ictrus, cyanosis, clubbing, lymphoadenopathy

SYSTEMIC EXAMINATION - 

PER ABDOMEN : DISTENDED, unblicus inverted SOFT, TENDER in Rt iliac fossa, Rt lumbar, rt HYPOCHONDRIUM

CARDIOVASCULAR SYSTEM : S1 AND S2 HEARD , NO MURMURS

RESPIRATORY SYSTEM : 

BILATERAL AIR ENTRY PRESENT, decreased breath sounds - Wheeze present in Rt>Lt IAA, IMA, ISA

CENTRAL NERVOUS SYSTEM : NAD

Ultrasound

Rt kidney - 6.4*3 cm CMD lost, PCS NORMAL

Rt kidney - 5.7*2.9 cm CMD lost, PCS NORMAL

Chest X-ray

Diagnosis

Chronic kidney disease with A/E of COPD WITH metabolic acidodis, and hypertensive emergency

Treatment

Fluid restriction <1.5 l/day

Salt restriction <2g/day

Inj. Lasix 40mg IV BD

T. Nodosis 500mg BD

T. Bio-D3 0.5 mg OD

T. OROFER - XT PO OD

NEB. DOULIN 6TH HRLY

NEB. BUDICORT 8TH HRLY

INJ. ERYTHROPOIETIN 4000 IU SC WEEKLY

HEMODIALYSIS DONE ON 12/3/22

HEMODIALYSIS DONE ON 14/3/22