GENERAL MEDICINE CASE 5

Nov 5 , 2021

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A 58 year old male patient who was agricultural worker by occupation ;was presented to OPD 2 ½yrs back  with the chief complaints of swelling of the legs and body pains.

HISTORY OF PRESENT ILLNESS : 

The patient was apparently normal 4 years back ,Then the patient has suffered from fever 4 yrs back and visited the hospital.

In the general checkup he was identified with the increase in the blood pressure and was prescribed with the medicines. One tab. Daily in the morning

The fever subsided.

After 2yrs he identified swelling in the legs and diffuse body pains and difficulty in walking due to pain.

He went to the local hospital and the swellings subsided with the medication. But he was suggested for the dialysis 2½ yrs back.

PAST HISTORY : 

Known patient of hypertension.

HISTORY OF PAST ILLNESS: 

The patient has no history of surgeries in the past;no known allergies;or TB ,asthma,CAD.

PERSONAL HISTORY:

The patient complains of decreased appetite.

Diet changed after the problem.earlier the patient had mixed diet with non- veg; now he stopped having chicken and mutton and having only fish.

Normal bowel and bladder movements.

Decreased sleep since 2months due to pain in the back and radiating to the abdomen.

The patient used to have the habit of toddy 2bottles daily,after work in the evening.

Currently the patient has addictions.

FAMILY HISTORY:

the patient has no known family history of diabetes ,CAD,asthma.

GENERAL EXAMINATION:

The patient is conscious, coherent,co operative and well oriented to time and place.

Patient has no signs of pallor, icterus ,cyanosis and clubbing, lymphadenopathy.

VITALS:

BP.      :140/80 mm Hg

PR.      :84bpm

R.R.     :22 cpm

Temp. :afebrile

GRBS.  :133

SPO².   :98

SYSTEMIC EXAMINATION:

CVS :

No thrills.

Cardiac sounds:S1 and S2 heard.

RESPIRATORY SYSTEM:

Position of trachea : central.

Breath sounds: vesicular.

Adventitious sounds: none.

ABDOMEN:

shape : scaphoid.

No palpable mass identified.

Free fluid: no.

Liver and spleen : not palpable.

Bowel sounds :yes.

* Bilateral pitting type of  pedal edema identified

Swelling of the upper left arm is observed since 4 months. The swelling is subsided  by medication and re appeared.

INVESTIGATIONS:

RFT : 20/10/21

Serum iron:83ug/dl.

ECG:

PROVISIONAL DIAGNOSIS:

Chronic renal failure

TREATMENT : 

The patient is undergoing periodic dialysis i.e; 2 cycles per week

 

MEDICATION  : 

Fluid restoration<1.5 litres/day

Salt restoration <2gm/day

Tab. Nocardia 10 mg TID

Tab.Lasix 40 mg OD

Tab. nodosis 500 mg OD

Tab.shelcal OD

Erythropoietin 4000IU(once weekly)

Questions:

1) What is the reason for the swelling of the left 

     upper limb after 2yrs of start of dialysis?