62 year old female with diabetic nephropathy

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those clinical problems with collective current best evidence based inputs.


Chief Complaints-

~Pedal Edema since 1 month.

~Nausea and vomiting since 10 days.


History of Presenting Illness-

Patient was apparently asymptomatic 6 months back and then on routine checkup,she was found to be having kidney problem and was on medication.Since 1 month,she developed pedal edema which is insidious in onset and gradually progressive,Bilateral pitting type extending up to knees.Vomiting since 10 days associated with nausea and decreased appetite.


Past History-

No history of shortness of breath 

Decreased urine output 

History of Type 2 Diabetes since 10 years,on medication.

No history of hypertension,tuberculosis,epilepsy,asthma.


Treatment History-

On medication for diabetes since 10 years.


Personal History-

Appetite-decreased

Diet-Mixed

Bowel-Regular 

Micturition-Normal 

Known allergies-none 

Habits/addictions-none 


Family History-

Insignificant 


Menstrual History-

Insignificant 


Obstetric History-

Insignificant 


General Examination-

Pallor- yes

Icterus-no

Cyanosis-no

Clubbing of fingers and toes-no

Lymphadenopathy-no

Oedema of feet-yes

Malnutrition-yes 

Dehydration-no 


VITALS

TEMP:afebrile(98.6f)

PR:82bpm

RR:22cpm

BP:140/90mmhg

Spo2:98% at room air


SYSTEMIC EXAMINATION 

CVS:S1 S2 HEARD

CNS:NAD

RESP: normal vesicular sounds

P/A: no palpable masses 

 


Hb:6.3(12-16g/dl)

Total count:6500

Neutrophils:58%

Lymphocytes:32%

Eosinophil:5%

Monocytes:5%

Basophils:0

PCV:19.1*(40-50vol%)

MCV:92.3fl

MCH:30.4pg

MCHC:33%

RDW-CV:13.1%*(11.6-14%)

RDW-SD:44.2(39-46)

RBC:2.07millions/cc*(4.5-5.5)


RFT

UREA:73mg/dl*(12-42mg/dl)

CREATININE:5.4mg/dl*(0.9-1.3mg/dl)

Uric acid:6.4mg/dl

Calcium:9.5mg/dl

Phosphorus:3.8mg/dl

Sodium:135meq/l

Potassium:4.2meq/l

Chloride:101meq/l


Random Blood sugar-153mg/dl 


Serum iron-62ug/dl


Provisional diagnosis-

Pitting type of bilateral pedal edema due to diabetic nephropathy.


Treatment-

T-Lasix 

T-Nodosis

Injection-HAI

T-Orofer









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