A 45 yr old male patient with nephrotic syndrome.
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CHIEF COMPLAINT:
A 45 yr old male patient welder by occupation came to the opd with complaints of shortness of breath,edema of legs,facial puffiness and body pains since 6 months .
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 2 yrs back when he developed SOB (grade 4)and bilateral pedal edema and visited a local doctor.The symptoms were relieved on medication.
After few days he developed similar episode and went to the hospital in khammam and was referred to nims hospital.
Patient was diagnosed of nephrotic syndrome in nims hospital by biopsy.
He had a similar episode of sob and developed anasarca for which he visited the hospital on 31st October.
Bilateral pedal edema is subsided on walking.
Patient complaints of weight loss of 5 kg in a 6 months period.
He complaints of decreased urine output and frequency.
Patient complaints of pain at the knee and ankle joint on palpation.
Patient has radiating(pricking) type of pain near the sacral region in the back.The pain radiates to the sides on the lower back region and to lower limbs.There is edema present in that region.
Patient has a distended abdomen.
He complaints of alternative diarrhoea (around 3-4 episodes/day)and constipation.
PAST HISTORY:
The patient had a first attack of seizures 2 yrs back associated with pedal edema.He went to mamata hospital for treatment where patient had 20 bouts of seizures for every 20-30 min in a single day .Then he was recovered.
Patient had a similar complaint of seizures after six months after he was cured.
Before the onset of attack of seizures (Complex Partial Seizures -Hemiparesis)he experienced numbness,tingling and dizziness.
He is k/c/o of diabetes since 6yrs and k/c/o hypertension since 6 months.
PERSONAL HISTORY:
Inadequate sleep.
Normal appetite.
Mixed diet intake.
Bowel and bladder movements are irregular
No history of smoking but an occasional alcohol consumption since 10 years.
Patient has a habit of chewing pan since 2 yrs.
No apparent history of drug allergy.
FAMILY HISTORY:
No history of relevant history found .
GENERAL EXAMINATION:
Patient was conscious, cooperate and coherent at the time of joining .
Pallor
No icterus
No cyanosis
No clubbing
Pedal edema is present
No generalized lymphadenopathy
VITALS:
Temperature-98.5F
Pulse-82 beats/min
Bp-120/80mm Hg
Respiration rate-20 /min
SYSTEMIC EXAMINATION :
CVS
No thrills
S1 S2 heard
No murmurs
RESPIRATORY SYSTEM
No dyspnoea
Position of trachea-central
Breath sounds-vesicular
ABDOMEN
Shape of abdomen-scaphoid
No tenderness
Bowel sounds-present
No bruits
CNS
Patient is conscious
Speech is present.
INVESTIGATIONS:
PROVISIONAL DIAGNOSIS :
Nephrotic syndrome
TREATMENT :
Tab Ecosprin AV/Po/HS
Tab Livogen Po/OD
Tab Nodosis 500mg/Po/BD
Tab PAN 40mg Po/OD
Fluid restrictions <2litres/day
Salt restrictions <2g/day
Tab CELGLIM Po/OD
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