60 YR OLD MALE PATIENT WITH CRF

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Team:

Interns-

M Supriya

Mohitha

K Sowmya

Sanjay

Amrutha

Dr.Druga Krishna PGY1

Dr.Ajith Kumar PGY2

Dr.Laxma Reddy PGY3

Dr.Manasa PGY3

Dr.Vijaya Lakshmi (Ast.Prof.)

60yr Old male  Patient came to the hospital

 c/o vomitings 5episodes since today morning which is nonbilious 

c/o lower back ache since 10 years decreased urine output since 2 months relieved with medication 

H/o palpitations occasionally 

H/o pedal edema blood in stoles 2 years back
past History
history of similar complaint in past 2 years back history of hemodialysis 1 session 5 years back
Known case of CKD sin 6 years on medical management

 k/c/o Hypertension Since 4 years and on tablet cilinidipine 10 mg po/od
K/c/o Diabetes mellitus since 20 years on injection mixtard 5IU---x---x
Personal history
History of smoking stop ten years back  to 2 times per week
History of alcohol last drank 10 days back
On examination
Patient is conscious coherent cooperative
Vitals
Temp -afebrile
BP      -210/120 mmHg
PR      -90bpm
RR      -18cpm
Systemic Examination
cvs-s1,s2 +
R/s-BAE+
P/A-Soft,non tender ,no organomegaly
CNS-NAD

Treatment 
1.SALT AND FLUID RESTRICTION
2.Inj LASIX 40 MG IV/BD
3.TAB.NICARDIA10MG PO/TID
4.TAB.ZOFER 4MG/IV/TID
5.INJ HAI S/C ACC. TO SLIDING SCALE
6.TAB OROFER XT PO/OD
7.TAB SHELCAL CT PO/OD