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, associated with decreased urine output, Foleys catheterization was done in outside hospital .

He was diagnosed with Tuberculosis of Lung in 2016 , completed his 6 months course of Antitubercular therapy (contact history unknown).

This man is also a chronic alcoholic , toddy drinker (sometimes) and a chronic smoker but stopped since 1 year , His every day drink was about 80-100 ml (brand no specific ), used to smoke 5-6 cigarettes per day sometimes a full packet . The reason for his stoppage was  diagnosed with chronic liver disease / viral hepatitis (HCV+ve ,HBe ag   +ve ) ,chronic kidney disease ( serum creatinine 3.5 mg/dl ) .

On presentation he looked very exhausted with heavily breathing and couldn’t be able to complete his talk while giving his history .He was not able lie down in supine position with his sob which made him sit up straight whole the time , we put him on 4L of 0xygen and started nebulization with Duolin, Budecort,Mucomix.Inj. Sodabicarb:50meq followed by 25 meq.

Inj.Decadron 8 mg iv /stat, 

Inj.Methylprednisolone 1gm iv/stat 

Syp.Digiraft 10 ml po given.

Inj. Lasix 40mg iv stat was given .

 

He is a known case of Diabetes type 2 ,Hypertension since 5 years on irregular medication?

Chest x ray was done outside reports showing multiple opacities over the hilar region suggesting history of TB. 

Hrct done showing Corads-3 ,(but RAT -ve ),? Pleural effusion.

Personal history  :decreased appetite since 2 days

Didn’t pass stools since3 days

?constipation 

Decreased urine output (In Urobag urine is dark in colour ) .

Vitals Bp :120/80mm of Hg

           Pr:89bpm .

           Spo2: 98% with 4 liters of Oxygen .

          Rr: 27-30 cycles per minute.

General examination patient is conscious, coherent ,not so cooperative, well built , nourished. 

He ‘s lower palpebra showing pallor, koilonychia+,swelling of legs (grade -1).

He had a history of loss of weight in 2016(back then when he was diagnosed with Tb).

Now he presented with increased weight with abdominal distention ?Ascites .

Height 5’5 ,Weight :66kg 

Abdominal examination showing smiling umbilicus , flanks are full ,fluid thrill positive ,no engorged veins .

Neurological examination done showing all nerves intact .

Couldn’t do the further examination and investigations because patient underwent LAMA.

 

Diagnosis :Chronic liver disease?Viral hepatitis,Chronic kidney disease, Abdominal distention?Ascites,Sob under evaluation.