INTRODUCTION

A 60 year old female patient ,house wife by occupation and region of Nalgonda, presented to the casualty with chief complaints of
                 ✓Grade 4 shortness of breath
                ✓ Bilateral pedal edema
                 ✓Nil urine output (5 sessions HD done). 
   Patient was apparently asymptomatic 10 days ago , then she developed dry cough and shortness of breath (grade 2)
✓ post covid pneumonia 10 days ago 
     CORADS  - 5/5
     CTSI - 21/25(10 days ago)

HISTORY OF PRESENT ILLNESS:

✓ Fever positive  - 10 days ago later subsided.
✓ patient attenders checked her GRBS which was 800 mg/dl - 10 days ago .so they visited local hospital where she was COVID-19 positive and treated her pneumonia.


HISTORY OF PAST ILLNESS:

✓In c/o nil urine output , hemodialysis was initiated on 21/03/21 and 5 sessions of HD done 
✓ patient  used to feel  better during dialysis and developed SOB next day.
✓ Bilateral pedal edema positive,pitting type extending upto skin 
✓ No c/o loss of appetite 
✓ No vomitings and loose stools
✓ No facial puffiness
✓ No h/o chest pain 
✓No orthopnea and PND 
✓ No h/o yellowish discoloration of eyes

PERSONAL HISTORY:
✓Married 
✓occupation - House wife 
✓Appetite - Normal
✓Non vegetarian
✓Bowels- Regular 
✓Micturition - Normal 
✓ No drug allergies

FAMILY HISTORY:
✓ No  significant family history

GENERAL EXAMINATION:
✓Patient is conscious, coherent, co-operative.
✓ pallor 
✓No icterus,cyanosis, clubbing, lymadenopathy, malnutrition, dehydration.
✓Edema

VITALS:

✓Pulse rate - 100 BPM 
✓BP- 140/70 mmHg
✓Spo2 at room air-88  percent
✓GRBS-353 mg/dl

SYSTEMIC EXAMINATION:

Cardiovascular system:
✓S1 S2 heard  
✓No murmurs
✓No thrills

Respiratory system:
✓Position of trachea-central
✓Dyspnoea -yes 
✓ No wheeze 
✓Bilateral fine cysts positivepositive
✓Normal vesicular breath sounds-heard

Per abdomen:
✓ shape of abdomen - Obese  and non tender.
✓Hernial orifices-normal
✓No palpable masses
✓Bowel sounds heard
✓ No free fluid 
✓ No Bruits 
✓ liver -  not palpable 
✓ spleen - not palpable

Central nervous system:
✓ level of consciousness - alert 
✓Speech-normal
✓No signs of meningeal irritation
✓Motor and sensory system-normal
✓Cranial nerves: intact
✓Reflexes : present

INVESTIGATIONS:
Liver function test:


Prothrombin time:


Serum iron:

Urine for ketone bodies:

Rft:

HIV 1/2 rapid test:


HBs Ag- RAPID:

Blood sugar - random:

Anti-HCV antibodies- RAPID:

ABG:

PT:

Blood grouping and RH type:

APTT:

CUP:

Hemogram:








PROVISIONAL DIAGNOSIS:

✓ post Covid -19 pneumonia  ? ARDS - Type 1 respiratory failure.
✓ ? AKI on CKD 
✓ k/c/o - Diabetes Mellitus -2( 10 yrs)
✓ DKA 
✓ old IWMI

TREATMENT GIVEN:
1)propped up posture 
2)Inj. Lasix 40 mg/iv/Bp
3)Inj pan 40 mg /iv/BD 
4) Inj. Zofer 4 mg/iv/BD 
5)Inj. Optineuron 1 amp in 100 ml  NS/IV/OD .
6) Inj meropenem 500 mg/IV/BD.
7)o2 inhalation @ 6-8 lit/min 
8)fluid restricion  < 1.5L/day 
   Salt restriction     < 2g/day 
9)Neb  duolin - 8th  july
             Budecort -12 th July 
10)Tab pan 650 mg/PO/80 s 
11)Tab Nodosis 500 mg/PO/BD
12)Tab Drofem XT/PO/BD
13)Tab shelcal 500mg/PO/OP
14)strict I/O charting
15)GRBS charting hourly 
16) Bp/PR/ump - 4 th july 

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