CARDIOGENIC PULMONARY EDEMA SECONDARY TO CAD HEART FAILURE WITH MIDRANGE EJECTION FRACTION (EF 40%) K/C/O CKD SINCE 1 YR K/C/O DM 2 SINCE 10 YEARS

 C/O SHORTNESS OF BREATH SINCE YESTERDAY 10PM

HOPI

PATIENT WAS APPARENTLY ASYMPTOMATIC BEFORE 10PM YESTERDAY SUDDENLY SHE HAD SHORTNESS OF BREATH WHICH IS SUDDEN IN ONSET GRADUALLY PROGRESIVE (GRADE 2 NYHA ) NO H/O FEVER, COUGH, COLD, VOMITINGS, DIARRHOEA, BURNING MICTURITION, DECREASE IN URINE OUTPUT SHE HAD SIMILAR COMPLAINTS ON 1/3/24 AND ADMITTED IN GOVERNAMENT HOSPITAL AND TREATED THERE DISCHARGED ON 3/3/24 AND THEN SHE RECOVERED

K/C/O CKD WITH DIABETIC NEPHROPATHY AND ADMITTED IN OUR HOSPITAL WITH COMPLAINTS OF VOMITINGS AND EPIGASTRIC PAIN ON 16/9/23 AND DISCHARGED ON 19/9/24

PAST HISTORY

K/C/O DM SINCE 10YRS ON TAB GLIMI M1 PO/OD NOT USING ANY MEDICATION SINCE NOV 2023

NO H/O DM, TB, ASTHMA. HTN, EPILEPSY

GENERAL EXAMINATION


PT IS C/C/C

TEMP - 98.6F

PR - 130BPM

RR - 30CPM

BP - 130/80MMHG

SPO2 - 86% @ RA

GRBS - 464MG %

SYSTEMIC EXAMINATION

CVS - S1, S2 +, NO MURMURS

CNS - NFND

RS - B/L DIFFUSE FINE CREPTS PRESENT

P/A - SOFT NONTENDER

PULMO REFERAL WAS DONE I/V/O ? PULMONARY TB

AND ADVISED TO REVIEW WITH REPORTS

COURSE IN THE HOSPITAL

50 YR OLD FEMALE FARMER BY OCCUPATION K/C/O DM 2 SINCE 10 YRS K/C/O CKD WITH DIABETIC NEPHROPATHY SINCE 6 MONTHS WHO IS ON IRREGULAR MEDICATION CAME WITH C/O SOB AND ON ADMISSION VITALS WERE

TEMP - 98.6F

PR - 130BPM

RR - 30CPM

BP - 130/80MMHG

SPO2 - 86% @ RA

GRBS - 464MG %

6UNITS OF IV INSULIN WAS GIVEN AND NECCESSARY INVESTIGATIONS WERE DONE HRCT SHOWED -

-BILATERAL CENTRAL / PERIHILAR AIR SPACE OPACITIES FEATURES SUGGESTIVE OF PULMONARY EDEMA

SEGMENTAL ATELECTASIS IN B/L LUNG LOWER LOBES

B/L MODERATE PLEURAL EFFUSION

MULTIPLE CYSTS IN BOTH KIDNEYS

AND TROPONIN I 130.3PG/ML AND DIAGNOSED TO BE

CARDIOGENIC PULMONARY EDEMA SECONDARY TO CAD


HEART FAILURE WITH MIDRANGE EJECTION FRACTION (EF 40%)

K/C/O CKD SINCE 1 YR

K/C/O DM 2 SINCE 10 YEARS AND STARTED ON ANTIBIOTICS, ECOSPIRIN, INJ HAI ACCORDING TO GRBS, INJ LASIX AND NEB WITH IPRAVENT 6TH HOURLY , BUDECORT 8TH HOURLY PULMONOLOGY REFERRAL WAS DONE AND ADVISED CONTINUE SAME TREATMENT AND PATIENT IMPROVED SYMPTOMATICALLY AND DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION

PROVISIONAL DIAGNOSIS 


CARDIOGENIC PULMONARY EDEMA SECONDARY TO CAD

HEART FAILURE WITH MIDRANGE EJECTION FRACTION (EF 40%)

K/C/O CKD SINCE 1 YR

K/C/O DM 2 SINCE 10 YEARs


Investigation

ABG 10-03-2024 09:10:AMPH 7.351PCO2 20.0PO2 116HCO3 10.8St.HCO3 14.1BEB -13.2BEecf - 13.8TCO2 22.8O2 Sat 94.6O2 Count 13.0

BLOOD UREA 10-03-2024 108 mg/dl SERUM CREATININE 10-03-2024 3.4 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 10-03-2024 SODIUM 141 mmol/L POTASSIUM 5.6 mmol/L CHLORIDE 106 mmol/L HBsAg-RAPID 10-03-2024 Negative

Anti HCV Antibodies - RAPID 10-03-2024 Non Reactive

FBS # 477mg/dLPOST LUNCH BLOOD SUGAR 10-03-2024 321 mg/dl

BLOOD GROUP RH TYPING : B POSITIVE (+VE)

HEMOGRAM 10-03-2024

HAEMOGLOBIN # 9.6 gm/dlTOTAL COUNT # 14,800 cells/cummRBC COUNT 3.85 millions/cummPLATELET COUNT 4.70 lakhs/cu.mmIMPRESSION :Normocytic normochromic anemia with neutrophilic leukocytosis and thrombocytosis .

SERUM IRON 54ug/dl

URINE FOR KETONE BODIES: NEGATIVE(-VE)

LIVER FUNCTION TEST (LFT) 10-03-2024 Total Bilurubin 1.14 mg/dl Direct Bilurubin 0.17 mg/dl SGOT(AST) 12 IU/L SGPT(ALT) 11 IU/L ALKALINE PHOSPHATASE 245 IU/LTOTAL PROTEINS 7.9 gm/dl ALBUMIN 3.55 gm/dl A/G RATIO 0.82COMPLETE URINE EXAMINATION (CUE) 10-03- 2024 COLOUR Pale yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR +BILE SALTS NilBILE PIGMENTS NilPUS CELLS 3-4EPITHELIAL CELLS 2-3RED BLOOD CELLS plentyCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil

SERUM ELECTROLYTES (Na, K, C l) 10-03-2024 SODIUM 137 mmol/L POTASSIUM 4.8 mmol/L CHLORIDE 99 mmol/L BLOOD UREA 11-03-2024 05:19:AM 125 mg/dl

HEMOGRAM

HAEMOGLOBIN # 8.0gm/dl

TOTAL COUNT # 15,500 cells/cummRBC COUNT # 3.28 millions/cummPLATELET COUNT 4.0 lakhs/cu.mmIMPRESSION : Normocytic normochromic Anemia with Leukocytosis.

SERUM CREATININE 11-03-2024 3.4 mg/dl SERUM ELECTROLYTES (Na, K, C l) 11-03-2024 SODIUM 141 mmol/L POTASSIUM 4.5 mmol/L CHLORIDE 105 mmol/L


TROPONIN-I # 130.3 pg/ml

T3, T4, TSH 11-03-2024 T3 0.51 ng/ml T4 13.42 micro g/dl TSH 0.96 micro Iu/ml lBLOOD UREA 11- 03-2024 120 mg/dl l

SERUM CREATININE 11-03-2024 3.4 mg/dl SERUM ELECTROLYTES (Na, K, C l) 11-03-2024 SODIUM 137 mmol/L POTASSIUM 3.8 mmol/L CHLORIDE 102 mmol/L

HAEMOGLOBIN# 8.1gm/dlTOTAL COUNT# 12,600cells/cummRBC COUNT # 3.16millions/cummPLATELET COUNT 3.72lakhs/cu.mmIMPRESSION Normocytic normochromic Anemia with Leukocytosis.

24H URINE PROTEIN/CREATININE RATIO

24 HOURS URINE PROTEIN 480 mg/day.

24 HOURS URINE CREATININE 0.9g/dayRATIO 0.53URINE VOLUME 2,000ml

HEMOGRAM 12-03-2024

HAEMOGLOBIN# 8.1gm/dl

TOTAL COUNT# 12,600cells/cummRBC COUNT# 3.16millions/cummPLATELET COUNT3.72lakhs/cu.mmIMPRESSIONNormocytic normochromic Anemiawith Leukocytosis.

BLOOD UREA 12-03-2024 111 mg/dl SERUM CREATININE 12-03-2024 3.6 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 12-03-2024 SODIUM 140 mmol/L POTASSIUM 3.9 mmol/L

TROPONIN-I # 130.3 pg/ml

T3, T4, TSH 11-03-2024 T3 0.51 ng/ml T4 13.42 micro g/dl TSH 0.96 micro Iu/ml lBLOOD UREA 11- 03-2024 120 mg/dl l

SERUM CREATININE 11-03-2024 3.4 mg/dl SERUM ELECTROLYTES (Na, K, C l) 11-03-2024 SODIUM 137 mmol/L POTASSIUM 3.8 mmol/L CHLORIDE 102 mmol/L

HAEMOGLOBIN# 8.1gm/dlTOTAL COUNT# 12,600cells/cummRBC COUNT # 3.16millions/cummPLATELET COUNT 3.72lakhs/cu.mmIMPRESSION Normocytic normochromic Anemia with Leukocytosis.

24H URINE PROTEIN/CREATININE RATIO

24 HOURS URINE PROTEIN 480 mg/day.

24 HOURS URINE CREATININE 0.9g/dayRATIO 0.53URINE VOLUME 2,000ml

HEMOGRAM 12-03-2024

HAEMOGLOBIN# 8.1gm/dl

TOTAL COUNT# 12,600cells/cummRBC COUNT# 3.16millions/cummPLATELET COUNT3.72lakhs/cu.mmIMPRESSIONNormocytic normochromic Anemiawith Leukocytosis.

BLOOD UREA 12-03-2024 111 mg/dl SERUM CREATININE 12-03-2024 3.6 mg/dl

SERUM ELECTROLYTES (Na, K, C l) 12-03-2024 SODIUM 140 mmol/L POTASSIUM 3.9 mmol/L CHLORIDE 98 mmol/L

USG ABDOMEN

IMPRESSION - B/L RENAL CORTICAL CYST

B/L GRADE 3 RPD CHANGES IN KIDNEYS

B/L MILD TO MODERATE PLEURAL EFFUSION WITH UNDERLYING LUNG COLLAPSE AND CONSOLIDATORY CHANGES

2DECHO

RWMA +

MILD AR +, MODERATE MR + WITH PAH

MODERATE LV DYSFUNCTION PRESENT

GRADE 1 DIASTOLIC DYSFUNCTION

MINIMAL PE +, PLEURAL EFFUSION PRESENT

BLOOD C/S REPORT : NO GROWTH AFTER 48 HOURS OF AEROBIC INCUBATION.

URINE C/S REPORT: NO BACTERIAL GROWTH.

HRCT CHEST

-BILATERAL CENTRAL / PERIHILAR AIR SPACE OPACITIES FEATURES SUGGESTIVE OF PULMONARY EDEMA

SEGMENTAL ATELECTASIS IN B/L LUNG LOWER LOBES

B/L MODERATE PLEURAL EFFUSION

MULTIPLE CYSTS IN BOTH KIDNEYS

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION <1.5 L /DAY

SALT RESTRICTION <2G/DAY

TAB AUGMENTIN 625MG PO/BD

TAB CLINDAMYCIN 600MG PO/BD

INJ HAI SC /TID 5 UNITS

TAB LASIX 40MG PO/BD

NEB WITH IPRAVENT 6TH HOURLY , BUDECORT 8TH HOURLY

TAB NODOSIS 500MG PO/BD

TAB METFORMIN + VILDAGLIPTIN 500/50 PO/BD

TAB OROFER XT PO/OD

TAB SHELCAL 500MG PO/OD

TAB MET-XL 12.5MG PO/OD

TAB ECOSPIRIN GOLD PO/HS

Advice at Discharge

FLUID RESTRICTION <1.5 L /DAY

SALT RESTRICTION <2G/DAY

INJ HAI SC /TID 5 UNITS 8AM 5U----1PM 5U---8PM 5U

TAB LASIX 40MG PO/OD ONCE DAILY AT 8 AM

TAB NODOSIS 500MG PO/BD TWICE DAILY

TAB METFORMIN + VILDAGLIPTIN 500/50 PO/OD ONCE DAILY

TAB OROFER XT PO/OD ONCE DAILY 2PM

TAB SHELCAL 500MG PO/OD ONCE DAILY 2 PM

TAB MET-XL 12.5MG PO/OD ONCE DAILY 8 AM

TAB ECOSPIRIN GOLD PO/HS AT NIGHT HALF HOUR(1/2) BEFORE SLEEP AT NIGHT

Follow Up

REVIEW TO GENERAL MEDICINE OP AFTER 2 WEEKS / SOS

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