55 year old male with bilateral lower limb swelling and facial puffiness
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55 year old man, fruit seller at NTR nagar Hyderabad presented to our casualty with the complaints of
Swelling of both his lower limbs since 4 months
Facial puffiness since 2 weeks
Cough since 3 days
He was previously working as a coolie at suryapet and got married to a farmer. He has 4 children, 3 daughters and a son. He has been drinking alcohol since 30 years, takes around 90ml of whiskey once a week. His last drink was 2 months ago.He used to even smoke around 5 beedis per day 20 years back.
Around 20 years back, he got diagnosed to be a diabetic on regular checkup and has been on regular medications ever since.
One year back, when he went for a routine diabetic checkup he got diagnosed to be a hypertensive but hasn’t been taking medications regularly.
8 months back, he developed blebs over his right and left foot after walking on a hot marble at suryapet. Subsequently he developed bilateral swelling of his lower limbs extending upto his thigh over a month. He visited a local hospital where he received certains medications after which which the swelling got resolved.
Since 4 months he started noticing swelling of both his lower limbs which progressed gradually to his thigh. Though he tells us no complaints of hematuria, frothy urine, dypsnea on exertion ,reduced urine out put, chest pain. 2 weeks back he started to notice facial puffiness.
2weeks back, one day he had giddiness after which he was taken to a hospital where he was put on 25% dextrose and was told that he was hypoglycaemic and OHAs were put on hold. In the coming days he even developed fever with chills after which he underwent screening for COVID 19 which came out to be negative. He was admitted in a local hospital and has apparently received certain antibiotics ( not mentioned which though) and was even on Tab Dytor plus. Since 3 days he has also been complaining of cough with scanty mucoid expectoration.
On presentation, he was obese
Pallor +, Peri orbital puffiness and bilateral pedal edema +
PR - 82bpm
Bp - 130/80mmhg
Afebrile
CVS - s1,S2 +
R/S - inspiratory fine crepts + in Bilateral IAA and ISA
Abdomen - non tender, bowel sounds +
CNS GCS 15/15
MOTOR RIGHT LEFT
TONE NORMAL NORMAL
POWER UL 5/5 5/5
LL 4/5 4/5
SENSORY
VIBRATION UL LOST LOST
LL LOST LOST
FINE TOUCH UL + +
LL - -
PAIN UL + +
LL + -
PROPROCEPTION UL + +
LL - -
REFLEXES BICEPS ++ ++
TRICEPS + +
SUPINATOR + +
KNEE + +
ANKLE + +
PLANTAR + -
Investigations
Treatment
FLUID RESTRICTION LESS THAN 1LIT PER DAY
SALT RESTRICTION LESS THAN 2.4GM PER DAY
INJ LASIX 40MG IV BD
INJ HUMAN ACTRAPID ACC TO SLIDING SCALE
TAB CILINDIPINE 5MG PO OD
TAB NEUROBION FORTE AT 2PM
MONITOR VITALS
TAB LINAGLIPTIN 5MG OD AT 8AM
TAB LASIX BD 40MG AT 8AM
20MG AT 6PM
TAB CININDEPINE 5MG OD AT 8AM
TAB NEUROBION FORTE OD AT 2PM
SYP ASCORIL 10ML PO BD
FLUID RESTRICTION <2LIT PER DAY
SALT RESTRICTION <2GM PER DAY
Diagnosis
CKD(?DIABETIC NEPHROPATHY)
DIABETIC NEUROPATHY(SMALL FIBER NEUROPATHY)
METABOLIC SYNDEROME
K/C/O HTN FROM 1YR AND DM- 2 FROM 20YRS
