52 yr old female with CKD
52 Yr old female housewife by occupation presented to casualty for maintenance haemodialysis.
Chief complaints::
Shortness of breath since 1 week
Pedal oedema since 1 week
Decreased urine output since 1 week.
History of presenting illness::
Pt. was asymptomatic 1 week back after which she developed shortness of breath and pedal oedema. Shortness of breath was aggravated by work.
No history of fever and vomiting.
Past history:
She is a known case of hypertension.
PERSONAL HISTORY:
Diet- mixed.
Appetite- reduced.
Sleep- adequate.
Bowel and bladder- regular.
No addictions.
FAMILY HISTORY:
No significant family history.
GENERAL EXAMINATION::
PALLOR- present.
ICTERUS: Absent.
Cyanosis: absent
Lymphadenopathy: absent
Oedema- absent.
Vitals :-
Temperature- Afebrile
Pulse rate- 72 beats per minute.
Respiratory rate- 20 breaths per minute.
B.P - 140/70 mm hg
Spo2 - 99% at room air
Systemic examination:
CVS:- S1 and S2 are heard,NO MURMUR
RS:- BAE+ , NVBS+
P/A SOFT ,NT
CNS :
Pt. was conscious, coherent and co-operative.
Speech was normal. No slurred speech.
No meningeal signs.
- No abnormality detected.
Reflexes:
Right and left biceps, triceps, ankle and supinator show grade 2 reflex
Gait: Normal.
Investigations..
1. Colour doppler 2D echo:
It shows -
Sclerotic aortic valve
Dilated rt. atrium, rt. Ventricle, left atrium.
Left ventricle - concentric left ventricular hypertrophy.
Conclusion- moderate left ventricular dysfunction, diastolic dysfunction.
2. CUE, HEMOGRAM, LFT findings.
3 Temperature recordings
4. TREATMENT HISTORY:
ECG:
Provisional diagnosis-
Chronic kidney disease.
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