70MALE CKD PTB

CHIEF COMPLAINTS 

A 70 YEAR OLD MALE FARMER BY OCCUPATION CAME TO CASUALITY IN 23-02-2024 WITH CHIEF COMPLAINTS OF 

C/O DIFFICULTY IN BREATHING SINCE 10 DAYS.

C/O FEVER SINCE 10 DAYS.

C/O COUGH SINCE 10 DAYS .


HISTORY OF PRESENT ILLNESS 

PATIENT WAS APPARENTLY ASYMTOMATIC 1 DAYS BACK THEN DEVELOPED SHORTNESS OF BREATH, INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE, GRADE 1-3

AGGREVATED WITH STRENBOUS EXERCISE, RELEIVED WITH REST.

C/O COUGH SINCE 10 DAYS ASSOCIATED WITH SPUTUM, WHITISH IN COLOUR, NON BLOOD STAINED ,NON FOUL SMELLING

C/O FEVER WITH CHILLS AND RIGORS,NO DIURNAL VARIATION.C/O DECREASED URINE

OUTPUT SINCE ONE MONTH.

NO COMPLAINTS CHEST PAIN, PALPITATIONS, ORTHOPNEA, PND 


PAST HISTORY

NOT A KNOWN CASE OF HTN ,DM,EPILEPSY, THYROID DISODERS 

PERSONAL HISTORY 

MIXED DIET

BOWEL REGULAR

DECREASED URINE OUTPUT SINCE 1 MONTH

ALCOHOLIC

SMOKER 


GENERAL EXAMINATION:

PATIENT IS CONCIOUS, COHERENT AND COOPERATIVE, MODERATLY BUILT AND NOURISHED 

TEMP - AFEBRILE

PR- 98 BPM

RR-16 CPM

BP- 140/90MMHG


SYSTEMIC EXAMINATION :

CVS - S1,52 HEARD, NO MURMURS RS - VESICULAR BREATH SOUNDS HEARD P/A- SOFT, NON-TENDER, NO ORGANOMEGALY CNS - NFND



COURSE IN HOSPITAL:

PATIENT WAS ADMITTED WITH C/O DIFFICULTY IN BREATHING SINCE 10 C

10 DAYS,COUGH SINCE 10 DAYS AND WAS INVESTIGATED FURTHER AND WAS DIAGNOSED AS

PULMONARY TUBERCULOSIS WITH MULTIPLE CAVITATORY LESIONS IN

,LINGULA, APICAL SEGMENT OFLEFT LUNG HEART FAILURE WITH PRESERVED EJECTION FRACTION CHRONIC KIDNEY DISEASE

ANEMIA SECONDARY TO CHRONIC KIDNEY DISEASE

ON 26/2/24 PULMONOLOGY REFERRAL WAS DONE INIO B/L LUNG FIELD HAZINESS 


CONTINUE SAME TREATMENT

NEB.BUDECORT 12TH HOURLY AND NEB.IPRAVENT 8TH HOURLY ON 29/2/24 REVIEW REFERRAL OF PULMONOLOGY WAS DONE

ADVISED-1. ATT UNDER NTEP H-5MG/KG PO/OD BBF

R-10MG/KG PO/OD BBF

Z-20MG/KG PO THRICE WEEKLY E-15MG /KG PO THRICE WEEKLY

2. TAB.BENADON 40MG PO/OD

REVIEW WITH SPUTUM REPORTS

PATIENT WAS MANAGED CONSERVATIVELY.

PATIENT WAS HAEMODYNAMICALLY STABLE AT TIME OF DISCHARGE


INVESTIGATIONS 




RFT

UREA 101 mg/di

CREATININE 3.6 mg/di

URIC ACID 7.0 mg/di

CALCIUM 9.0 mg/di

PHOSPHOROUS 3.8 mg/dI

SODIUM 140 mEq/L

POTASSIUM 4.0 mEq/L

CHLORIDE 106 mEq/L

LIVER FUNCTION TEST (LFT)

Total Bilurubin 0.45 mg/di

Direct Bilurubin 0.18 mg/dI

SGOT(AST) 11 IU/L

SGPT(ALT) 10 IU/L

ALKALINE PHOSPHATASE 192 IU/L

TOTAL PROTEINS 6.3 gm/di

ALBUMIN 3.2 gm/di

A/G RATIO 1.09

COMPLETE URINE EXAMINATION (CUE)

COLOUR Pale yellow

APPEARANCE Clear

REACTION Acidic

SP.GRAVITY 1.010

ALBUMIN +

SUGAR Nil

BILE SALTS Nil

BILE PIGMENTS Nil

PUS CELLS 3-4PUS CELLS 3-4

EPITHELIAL CELLS 2-3

RED BLOOD CELLS Nil

CRYSTALS Nil

CASTS Nil

AMORPHOUS DEPOSITS Absent

OTHERS Nill

HBsAg-RAPID : Negative

Anti HCV Antibodies - RAPID Non Reactive

HEMOGRAM:23/2/24

HB: 7.4MG/DL

TLC; 9400 CELLS/CUMM N/L/E/M/B: 73/15/2/10/0

PCV: 22.5VOL%

MCV: 80.4FL

MCH: 26.4PG

MCHC: 32.9%

RBC COUNT: 2.80 MILLIONS/CUMM

PLATELET COUNT: 2.6 LAKHS/CUMM

SMEAR:NORMOCYTIC NORMOCHROMIC ANEMIA

CE CT OF CHEST-

MULTIPLE THIN WALLED CAVITIES (WALL THICKNESS 6-7MM) IN RIGHT LUNG UPPER LOBE A SOLITARY THIN WALLED CAVITY (WALL THICKNESS 6-7MM) IN APICAL SEGMENT OF LEFT

LUNG UPPER LOBE

FEW THIN WALLEDE CAVITIES IN LINGULA

AIR FLUID LEVEL IN ON EOF THE CAVITY OF RIGHT UPPER LOBE

CENTRILOBULAR NODULES WITH A TREE IN BUDCONFIGURATION IN RIGHT UPPER LOBE LEFT LOWER LOE AND LINGULA. FEW AREAS OFNODULAR CONGLOMERATION RESULTING IN CONSOLIDATIVE PATTERNS F/S/O INFECTIVE ETIOLOGY LARGE HIATUS HERNIA HEMOGRAM:27/2/24

HB: 8.2MG/DL

TLC; 8400 CELLS/CUMM N/L/E/M/B: 74/13/3/10/0

PCV: 24.5VOL%

MCV: 78.3FL

MCH: 26.2PG

MCHC: 33.5%

PLATELET COUNT: 2.88 LAKHS/CUMM

SMEAR:MICROCYTIC NORMOCHROMIC ANEMIA

СВР:28/2/24

HB: 7.3MG/DL

TLC; 7800 CELLS/CUMM N/L/E/M/B: 75/12/4/9/0

PLATELET COUNT: 2.64 LAKHS/CUMM

SMEAR:NORMOCYTIC NORMOCHROMIC ANEMIA

RFT 28/2/24

UREA 100mg/dI

CREATININE 4.1 mg/di

URIC ACID 9.0mg/di

CALCIUM 9.9 mg/di

PHOSPHOROUS 5.3 mg/di

SODIUM 135 mEq/L

POTASSIUM 3.4 mEq/L

CHLORIDE 105 mEq/L

CRP- NEGATIVE ON 28/2/24

ESR 28/2/24- 140 MM/1ST HOUR

HEMOGRAM:28/2/24

HB: 7.7MG/DL

TLC; 9500 CELLS/CUMM N/L/E/M/B: 74/16/2/8/0

PCV: 22.8VOL%

uv. 22.8VOL%


MCV: 78.6FL

MCH: 26.6PG

MCHC: 33.8%

RBC COUNT: 2.90 MILLIONS/CUMM

PLATELET COUNT: 2.51 LAKHS/CUMM

SMEAR:NORMOCYTIC NORMOCHROMIC ANEMIA

RFT 29/2/24

UREA 113mg/di

CREATININE 4.1 mg/dI

URIC ACID 9.2mg/dI

CALCIUM 9.9 mg/di

PHOSPHOROUS 5.9 mg/di

SODIUM 137 mEq/L

POTASSIUM 3.2 mEq/L

CHLORIDE 103 mEq/L

ZN STAIN- ACID FAST BACILLI SEEN

KOH MOUNT- HYALINE SEPTATEHYPHAE SEEN

GRAM STAIN-PLENTY OF EPITHELIAL CELLS >15/PF ,MODERATEIN NUMBER OFPUS CELLS

5-6 /CPF, PLENTY OF GRAM POSITIVE COCCI IN PAIRS SPUTUM FOR C/S-28/2/24

GRAM STAIN-PLENTY OF EPITHELIAL CELLS (>15/LPF),MODERATE NUMBER OFPUS CELLS

(5-6/LPF),PLENTY OFGRAM POSITIVE COCCI PAIRS

ZN STAIN- AFB SEEN (GRADE 3 +)

CULTURE-PSEUDOMONAS SPECIES (?COLONIZER)


DIAGNOSIS 

PULMONARY TUBERCULOSIS WITH MULTIPLE CAVITORY LESIONS IN RIGHT UPPER LOBE ,LINGULA, APICAL SEGMENT OFLEFT LUNG

 HEART FAILURE WITH PRESERVED EJECTION FRACTION 

CHRONIC KIDNEY DISEASE[ STAGE II B] ANEMIA SECONDARY TO CHRONIC KIDNEY DISEASE


Treatment Given


FLUID RESTRICTION <1.5 L/DAY

SALI RESTRICTION <2 GM/DAY

INJ.NEOMOL 1 GM IV/SOS(IF TEMP >101F)

TAB.PCM 650MG PER ORAL THRICE A DAY (8AM-2PM-8PM)

TAB.OROFER XT PER ORAL ONCE A DAY (10AM-0-0)

TAB.LASIX20MG PER ORAL ONCE A DAY (10AM-0-0)

TAB.MET -XLL 25 PER ORAL TWICE A DAY(8AM-0-8PM)

TAB.NODOSIS 500MG PER ORAL TWICE A DAY(8AM-0-8PM) 

SYP.ASCORIL -LS PER ORAL TRICE A DAY(8AM-0-8PM)

TAB.NODOSIS Ju...

SYP.ASCORIL -LS PER ORAL TRICE A DAY(8AM-0-8PM)

TAB.LASIXACTONE PER ORAL TWICEADAY (10AM-0-5PM)

TAB.MET XL 25 PER ORAL TWICE A DAY (8AM-0-8PM)

TAB.ISONIAZID (4-6MG/KG)=5X45=225MG=3 TABLETS PER ORAL ONCE A DAY BEFOI

BREAKFAST

TAB.RIFAMPICIN (8-12MG/KG)=10 X 45 =450MG=3 TABLETS PER ORAL ONCE A DAY

BREAKFAST

TAB.PYRAZINAMIDE (20-30mg/kg)=25 X 45 =1125MG=3 TABLETS PER ORAL THRICE

TAB.ETHAMBUTAL (15-25MG/KG)=20 X 45 =900MG = 3TABLETS PER ORAL THRICE 




ADVICE AT DISCHARGE 

TAB.OROFER XT PER ORAL ONCE A DAY (10AM-0-0) X3MONTHS

TAB.NODOSIS 500MG PER ORAL TWICE A DAY(8AM-0-8PM) (TO BE CONTINUED)

TAB.MET XL 25 PER ORAL TWICE A DAY (8AM-0-8PM) (TO BE CONTINUED)

TAB.LASIX 40MG PER ORAL TWICE DAILY (TO BE CONTINUED)

TAB.SHELCAL PER ORAL ONCE DAILY X 10 DAYS(0-2PM-0)

TAB.VITAMIN D3 PER ORAL ONCE DAILY X 10 DAYS(0-2PM-0)

TAB.ISONIAZID 150 MG 1 1/2 TABLETPER ORAL ONCE A DAY BEFORE BREAKFAST TAB.RIFAMPICIN 300MG 1 1/2 TABLETS PER ORAL ONCE A DAY BEFORE BREAKFAST

TAB.PYRAZINAMIDE 750MG 1 1/2 TABLET PER ORAL ALTERNATE DAY TAB TAB.ETHAMBUTOL 600MG 1 1/2 TABLET PER ORAL ALTERNATE DAY

TAB.PCM 650 MG PER ORAL THRICE A DAY (8AM-2PM-8PM) X5DAYS




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