Chandana vishwanatham

 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.  24/4/21 19 Year old female came with cheif complaints of generalised swelling with decreased urine output since 10 days  complaints of multiple joint pains since 2 years  HOPI :-patient was apparently asymptomatic 2 years ago  Patient had complaints of fever with bilateral ankle ,knee  joint pain with swelling and difficulty in walking due to pain  Later within 1 week after the onset of these symptoms patient had bilateral interphalyngeal joint pains , elbow , shoulder wiyth restriction of movement  , swellings  Patient with these complaints visited a local doctor and was told to have rheumatoid arthritis started on Ta

 Case reference: https://elogformedicalcasebyintern.blogspot.com/2021/12/35-f-with-aki-on-ckd.html SOAP NOTES  D WARD 25/2/22 S:  C/O sob and abdominal distension since last dialysis O: Patient was C/C/C No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema Vitals at admission: PR- 80 bpm BP- 140/80 mmHg RR- 21 cpm SpO2- 98% CVS: S1 S2 +, RS: B/L AE + P/A: soft nontender . Ascitic tap was done on 23/2/22 showing high SAAG high protein SAAG value - 1.8 Ascitic protein - 3.0 A: ? NSAIDS induced nephropathy (H/o HTN since 2 months)  High SAAG high protein secondary to heart failure Recent hemodialysis: 23/2/22 Hemodialysis since 1 month 2 sessions per week P : 1. INJ. LASIX 40 mg IV BD 2. INJ PAN 40 mg IV OD  3. INJ ZOFER 4 mg IV OD 4. INJ erythropoietin 4000 IU SC once weekly 5. MONITOR VITALS 6. Tab OROFER XT PO  OD 7. Tab SHELCAL PO OD 8 T AMLONG 5 mg PO BD 9. T NICARDIA 20 mg PO OD

 History taken in August 18 2021 56 year old man, owns a restaurant at choutuppal presented with the complaints of Bilateral lower limb swelling since 1 month Reduced urine out since 20 days Abdominal distension since 7 days Scrotal swelling since 4 days Patient used to previously work as a farmer and later in 2004 he and his wife started running their local bandi for breakfast at Choutuppal. He even serves breakfast on cycle. He is a father of 2 children.   22 years back: He got diagnosed with pulmonary kochas for which he used ATT for 6 months   1 month back :  He first developed left lower limb swelling extending upto his ankle and he later gradually developed swelling of his right lower limb and the swelling in both his lower limbs extended upto his thighs He even had difficulty in passing stools for which he received enema outside  Since 20 days - he has been experiencing reduced urine output  10 days back - When he paid a visit to a hospital with these complaints he got diagnos