65 yr old male with pedal edema

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Case presentation:

A 65Y male, farmer by occupation resident of Nemmani,presented with chief complaints of burning micturation since 15 days,

cough since 10 days and

decreased urine output since 3 days.

Patient was apparently asymptomatic 2 months back later he developed B/L pedal edema pitting type which is insidious in onset progressed to abdomen and face  relieved  with medication. 

He also developed Shortness Of Breath(Grade 3) 2 months ago which is insidious in onset associated with Orthopnea, PND, aggravated with activity and relieved  on rest.

Then he developed burning micturation since 15days associated with fever and chills resolved with medication.

Then he developed cough since 10days non productive intermittent type no aggravating and relieving factors 

H/o Jaundice 1 week back for which he took Herbal medication for 5 days and stopped 3 days back.

Past History

N/K/C/O Diabetes,Hypertension, Asthma, CVA.

PERSONAL HISTORY:

Appetite lost

Mixed diet

Sleep adequate

Bowel movements regular

K/c/o smoker since 20yrs. 3-4 beedies/day

Occasionally alcoholic since 20 years.

O/E

 Pt is conscious and cooperative moderately built and nourished. 

Bp 110/50 mmhg

Pr 80 bpm

Rr 22cpm

Temp Afebrile

Pallor - absent

Icterus absent

Cyanosis - absent

Clubbing- absent

Lymphadenopathy - absent

Edema B/L pedal edema  upto thigh. 

CVS:

INSPECTION : no precordial bulge

Jvp raised upto bifurcation of carotid.

No visible pulsations, scars 

No engorged veins

PALPATION :

All inspectors findings are confirmed 

Apical impulse at 5th intercostal space 1 cm lateral to midclavicular line.

para sternal heave present

No palpable murmurs 

AUSCULTATION : S1S2 heard, no murmurs

Respiratory system:

Bilateral air entry present

Crepts present in left infrascapular and infra axillary areas.

P/A - Soft and non tender,no organomegaly

CNS- Higher mental functions intact

Sensory and motor systems intact on both sides

All cranial nerves intact on both sides

No cerebellar dysfunctions.

Investigations: 

CBP

Hb 10.7

TLC 8400

RBC 3.31 millions

RFT

Urea 142

Creatinine 7.3

Uric Acid 12

Na+ 135

K+ 4.1

Cl- 99

LFT 

CUE

Chest x ray

2d echo

Ecg

Treatment:

Fluid restriction 

Salt restriction

Propped up position 

Inj LASIX 40mg IV TID

SYP ASCORIL 15ml TID

Day 2 

No fresh complaints 

Decreased urine output 275 ml from 4pm to next day 8 am with Lasix 

Treatment: 

Lasix infusion 20 mg in 30 ml normal saline @5ml/hr is started .

Rft

DIAGNOSIS

?HFpEF with AKI 2' TO UNKOWN HERBAL MEDICATION