A Middle aged Male with CKD, CLD, ?Ascites, ?Sob .
A 46 year old male who is a farmer presented to the casualty in the midnight with complaints of shortness of breath since 1 day which started in the early morning around 4:00am which woke him from his sleep , abdominal distention with decreased urine output since 3 days ,was taken to the outside hospital and referred to our center. He complained that , this “ayasam” didn’t let him rest for a second . He gave a history of similar complaints in the past with intermittent attacks of shortness of breath ,fever associated with chills and was rushed to the hospital during midnights , those episodes lasts for 1-2 days got subsided with treatment , was told that his hb :9.5 gm/dl causing his sob. He gave a clear history that every episode made him very uncomfortable to sleep , he used to go near the windows /out of the house to catch the fresh air. He gave a history of abdominal discomfort with abdominal distention and decreased appetite since 3 days ,didn’t pass stools since 3 days,