General medicine case 5

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A 85 year old male labourer by occupation came to causality with chief complaints of lower back pain and swellings of legs .

History of present illness: 

Patient was asymptomatic 3 months back then he had itching on hands and legs which was subsided . Later he developed pedal edema which was subsided on medication. 20 days back ,he developed ascites which was not subsided and patient also lost his appetite after he developed ascites .he visited and admitted in the hospital  

Past history :

Patient was daily labourer by work he used to get up in the morning and go to work by cycling . Patient had a cataract surgery for right eye 4 years back as he developed blurred vision . Now he developed blured vision for left eye which is not operated . 20 years back he had amputation of right leg thumb finger. He is partially deaf since1 year.  History of hypestension since 3 months. History of shortness of breath grade 4 since 3 months . 

Personal history : 

Diet : mixed

Sleep : Normal 

Apetite : loss of apetite 

Bowel and bladder movement : Normal 

Addictions : occasionally alcoholic 

Family history : 

 No similar history in the family 

Treatment History : 

No allergy to known drugs 

General examination: 

Patient is conscious and coherent and well built  . 

No cyanosis 

No clubbing 

No icterus 

Pallor present 








Vitals : 

Temp : 98°F 
Bp : 220 / 100mmHg 
Pulse: 72 beats / min 
Respiratory rate : 18cycles / min 

Systemic examination: 
 Cvs : S1 S2 heard no murmurs 
CNS : conscious, speech normal 
Respiratory: dysponea is present no wheezing sound 
Shape of abdomen : distended 
No palpable mass 
Spleen : non palpable 
Liver: non palpable 
Fluid is present 

Investigations: 

22/10 /21 





25/10/21 



2 /11 /21









Diagnosis : 

CKD 

Treatment: 

2/11/21 



Tab.nicardia 20mg BD 


Tab.lasix 40mg BD 


Tab.nodosis 300 mg BD 


Inj.erythropoitin 400 iv weekly once 


Tab .orofex BD 



3/11/21


Tab.nicardia 20mg BD 


Tab.lasix 40mg BD 


Tab.nodosis 300 mg BD 


Inj.erythropoitin 400 iv weekly once 


Tab .orofex BD 



5/11/21 



Tab.nicardia 20mg BD 


Tab.lasix 40mg BD 


Tab.nodosis 300 mg BD 


Inj.erythropoitin 400 iv weekly once 


Tab .orofex BD .

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