A 56 year male  patient workers in food center presented to opd with complain of swelling in leg and abdomen since 7 days ago.

History of present illness:

Patient was apparently asympmatic one month back .he then developed swelling in legs with no pain.they is gradually increase in swelling from legs to abdomen after 2 days .

Patient develops pedal edema of pitting type grade -1 .

After 10 days it is progressed to grade -2

Over 15 days pitting type grade 3

Patient has no complaints on fever, vomiting .

Past history:

1.Patient is suffering with hypertension since 3 month .he is undergoing into medication immediately 

2.no diabetes, no seizures,no epilepsy,no tuberculosis,no thyroid disorder 

3.patient had not undergone any surgeries 

4.patient had suffered from pulmonary koch’s 22 yrs back .patient has used ATT for 6 months.


Personal history: 

1.diet- mixed 

2.appetite- normal 

3 .bowel amd bladder movement- normal 

4 . Sleep- normal 

5. Addictions - no smoking and no alcohol consumption.


Family history:

No history of cvA/CAD/asthma/DMamily history:

No history of cvA/CAD/asthma/DM

No similar complaints in the family previously.

Allergic history:

No known allergy to pollen or food


Treatment history: 

not significant 

General examination: 

-Patient is conscious,coherent and co-operative 

-No pallor , no cyanosis,no icterus,no lymphadenopathy

- clubbing of finger is present 

- oedma of feet 

- no dehydration,no malnutrition

Vitals:

1-fever: a febrile 

2-BP -160/80 beats /min

3-pulse rate-120 bpm/min

4-Spo2-96%

Systemic examination:

1—CVS: inspection -chest wall is bilateral systemical 

-palpation - JVP -normal 

-auscultation-normal with regular heart beat

-S1,S2 are positive 

-no murmurs 

2—RESPIRATORY SYSTEM:

-Position of trachea- central,normal bilateral air entry,no AV sound 

- dyspnea is seen ,expiratory wheeze is positive in all area 

- breathe sound is vascular 

3.ABDOMEN:

-Shape of abdomen-distended 

-Tenderness and palpable mass is absent 

-free fluid is present 

- liver is not palpable 

- bowel sound are heard 

4 .CNS: 

-patient is conscious 

-speech is normal 

- neck stiffness is not seen

- cranial nerves ,motar system and sensory system is not affected 

- glass gow scalw -15/15

Investigations:

30/9/2021

-ascitic fluid protein sugar

Sugar-10%

Protein-0.8%

—AsciTic fluid for Idh

Ldh-5.8

SAAG-1.55

Serum albumin-2.0

Ascitic albumin-0.45

Reticulocyte count - 0.6

30/9/21:

LDH- 293

1/10/21:

Urea- 12.9

Creatine-6.6

Sodium-13.6

Potassium- 4.4

Cl- 10.5

Serum electrolytes:

Serum creatinine:

Blood urea:


Ascitic fluid protein sugar:

Ascitic fluid with LDH:

LDH:

Reticulocyte count:

SAAG:


ECG:

Nephrotic syndrome chat TPR:





Provisional diagnosis:
Nephrotic syndrome c-HTN


Treatment given:
1.fluid restrictions-less than 1lit /day
2.salt restriction-<2 g/day
3.tablets lasix— 60 mg/po/BD
4.tablet ramipril- 5mg
5. Tab .nodosis- 500mg /po/ BD
6.tab pano-40 mg /oD
7. Monitor out and abdomen girth-
8.I/O charting

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