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