45 year old male with shortness of breath

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45 years old male pt came to opd with cheif complaints of shortness of breath (grade 2-3) since 20 days , complaints of loss of appetite since 20 days.

Patient was apparently asymptomatic 35days back, then he developed shortness of breath for which he went to a local hospital after further investigation he was diagnosed with chronic kidney disease and underwent 4 sessions of dialysis.Then referred I/V/O dialysis.

He was diagnosed with hypertension 1 month back and is on regular medication( Tab. Nicardia 10mg od) since then.

Not a known case of DM, Thyroid, TB, asthama, epilepsy.

Apetite decreased since 20 days.

He takes mixed diet.

Bowel and bladder movements are regular.

No any known allergies.

Patient consumes alcohol 1 quarter of whisky/ day daily since 12 years.Last consumption was 20 days back.

He is a known smoker.2 packs of cigarettes/ day since 20 years.

On examination, patient is C/C/C,

Pallor present

No icterus, cyanosis , clubbing , lymphadenopathy.

Edema present

Temperature 98.5*F

PR : 88bpm

RR : 18 cpm

BP : 140/90 mmhg

Spo2 : 99% at RA

GRBS : 153 mg%

CVS :- 

S1, s2 heard.

RS :- BAE +

P/A :- soft, non tender.

CNS :- no any focal deficet.

Provisional diagnosis :-

CKD on MHD since 1 month

Rx :-

1) Salt restriction less than 2.4gm/day.

2)fluid restriction less than 1 lit/day.

3)Tab.Nicardia 20mg po/bd

4)Tab.Nodosis 550 mg po/od

5)Tab.Orofer XT po/od

6)Tab.Shelcal 500mg po/od

7)Inj. Erythropoitin 4000 IU S/c once in a week.

8) Inj Iron sucrose 2amp in 100ml NS.

9) Tab Lasix 40mg po/Tid