55 Y /M WITH HEART FAILURE , ? COPD , BELOW KNEEAMPUTATION

 

55 Y /M WITH HEART FAILURE , ? COPD , BELOW KNEEAMPUTATION 

55 Y / M pt presented to casuality with c/o 
Blurring of vision since 1 year 
Decreased urine output since 2 months 
Pedal edema since 1 month 
SOB since 3 days 
Distended abdomen since 2 days 

Pt was apparently asymptomatic 10 yrs back , then he was diagnosed with DM type 2 , on has been using Glimi 2 mg tablets 
Pedal edema was gradually progressive 
SOB grade 4 was more during the night , PND 
There are no aggregating and relieving factors 

Pt is a k/c/o DM since 10 yrs , on Tab Glimi 2 mg 
HTN since 2 yrs , on T. Telma 40 mg 

Surgical history : Pt had below knee amputation 1 yr back , due to trauma to the left lower limb which developed cellulitis 

Pt is an occasional alcoholic since 30 years 
Chronic smoker since 20 years ( daily 1 pack of cigarette and 1 pack of beedi ) 

Medical h/o : 
Pt is on T Atorvastatin 10 mg 
T Pentoxifyllin 400 mg since 1 yr 

Not a k/c/o tb , asthma 

Occupation : Mason 
Appetite : normal 
Diet : mixed 
B& B : decreased micturition 

Pallor present 

CVS: S1S2+
No murmurs 

RS: 
DYSPNEA + 
Wheeze + 
inspiratory crepts in b/l ISA , IAA , IMA 
Trachea position-central.
Vesicular breath sounds heard

 P/A: 
  Soft, non tender 
  DISTENDED 
  Bowel sounds heard .
  
CNS: NAD 

Provisional diagnosis : ? AKI with right heart failure 
? COPD , with left below knee amputation 
K/c/o Type 2 DM since 10 yrs 
HTN since 2 yrs 

Clinical images : 


Investigations : 

On 6/12/21 

USG ABDOMEN : 

2 D echo : 

ECG on 6/12/21 


ECG on 7/12/21 

On 8/12/21
S urea 169 
S creat 9.8 

Treatment : 
Fluid restriction 
Salt restriction 
Inj lasix 40 mg iv bd 
Inj HAI sc 8 am ....1 pm...8 pm
Neb with duolin 8 th hrly , budecort  12 hrly

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