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NEPHROTIC SYNDROME WITH HTN


 A 56 year old male came to the OPD with complaints of abdominal distension from 2 days 

CHIEF COMPLAINT : 

Swelling of abdomen since 2 days

HISTORY OF PRESENT ILLNESS:


Patient was apparently asymptomatic 2 and half months back ,then he developed pedal edema -pitting type grade 1 then gradually progressed to grade 2 over 10 days to grade 3 over 15 days

He first developed left lower limb swelling extending upto his ankle and he later gradually developed swelling of his right lower limb and the swelling in both his lower limbs extended upto his thighs

no complaints of fever, cough, burning micturation, loose stools, vomiting

No complaints of dyspnea, hematuria, frothy urine, no complaints of Chest pain, palpitations, orthopnea, PND

HISTORY OF PAST ILLNESS :

H/o pulmonary koch's 22 yrs back ,used ATT for 6 months

HTN since 2 months

PERSONAL HISTORY:

Married
Appetite-decreased
Regular bowel and bladder movements
Occasionally alcoholic


GENERAL EXAMINATION : 

Patient is conscious, coherent and cooperative  
Moderately built and moderately nourished 
Pallor present ,grade 3 clubbing
No Icterus, cyanosis Lymphadenopathy

B/L pitting type upto thighs

VITALS : 

Temp: afebrile 
PR: 120 bpm 
BP: 160/80 mm hg 
RR: 24 cpm  
Spo2 - 96% at RA  

CVS : 
S1, S2 heard , No murmurs 

RS : 
Position of trachea: central 
Bilateral decreased air entry + 
Expiratory wheeze + in all areas

PER ABDOMEN: 
Abdomen distended with no scars, sinuses, engorged veins 
No tenderness 

Percussion-
Shifting dullness +

Bowel sounds +



CNS: 
Patient is Conscious ,oriented to time,place and person 
HMF -intact 
Motor & sensory system: normal 
Reflexes: present 
Cranial nerves: intact 
No meningeal signs 


PROVISIONAL DIAGNOSIS-

NEPHROTIC SYNDROME WITH HTN

INVESTIGATIONS:














ECG:












Treatment


 DAY-1


TREATMENT:

1.FLUID RESTRICTION < 1 LIT/DAY

2.SALT RESTRICTION < 2 GM/DAY

3.TAB LASIX 60MG PO/TID

4.TAB RAMIPRIL 5 MG/PO/BD

5.TAB PAN-D PO/OD

6.MONITOR WT & ABDOMINAL GIRTH DAILY

7. I/O CHARTING

See

 DAY-2


TREATMENT :

1.FLUID RESTRICTION < 1 LIT/DAY

2.SALT RESTRICTION < 2 GM/DAY

3.TAB LASIX 60MG PO/TID

4.TAB RAMIPRIL 5 MG/PO/BD

5.TAB PAN-D PO/OD

6.MONITOR WT & ABDOMINAL GIRTH DAILY

7. I/O CHARTING




DAY-3



TREATMENT :



1.FLUID RESTRICTION < 1 LIT/DAY

2.SALT RESTRICTION < 2 GM/DAY

3.TAB LASIX 60MG PO/TID

4.TAB RAMIPRIL 5 MG/PO/BD

5.TAB PAN-D PO/OD

6.MONITOR WT & ABDOMINAL GIRTH DAILY

7. I/O CHARTING 







 
 DAY-4


TREATMENT :



1.FLUID RESTRICTION < 1 LIT/DAY

2.SALT RESTRICTION < 2 GM/DAY

3.TAB LASIX 60MG PO/BD

4.TAB RAMIPRIL 5 MG/PO/BD

5.TAB PAN-D PO/OD

6.MONITOR WT & ABDOMINAL GIRTH DAILY

7. I/O CHARTING





DAY-5


TREATMENT :



1.FLUID RESTRICTION < 1 LIT/DAY

2.SALT RESTRICTION < 2 GM/DAY

3.TAB LASIX 60MG PO/BD

4.TAB RAMIPRIL 5 MG/PO/BD

5.TAB PAN-D PO/OD

6.MONITOR WT & ABDOMINAL GIRTH DAILY

7. I/O CHARTING







Day 6-8

1.FLUID RESTRICTION < 1 LIT/DAY

2.SALT RESTRICTION < 2 GM/DAY

3.TAB LASIX 60MG PO/TID

4.TAB PAN-D PO/OD

5.MONITOR WT & ABDOMINAL GIRTH DAILY

6. I/O CHARTING





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