60 yr old male with CRF , ? FLASH PULMONARY EDEMA SECONDARY TO CRF , ? CARDIOGENIC PULMONARY EDEMA SECONDARY TO HF WITH REF , UNCONTROLLED HTN , ? KOCHS

60 year old male patient brought to casualty with c/o sob ( grade 4 ) since 5 days , decreased urine output , vomitings , pedal edema since 1 day

HOPI : 

Pt was apparently asymptomatic 5 days back then he developed sob which is gradual in onset and progressive which was associated with vomitings (watery), also developed pedal edema non pitting type and also presented with decreased urine output

PAST HISTORY: 

6 months back pt complained of giddiness and went for hospital dont know the reason but they have been tested for sputum for tb which turned out to be negative

3 months back in feb 2022 pt developed acute sob grade 4 associated with sweating , at this time the pt diagnosed with heart failure with decreased ejection fraction and  Renal failure ,  serum creatinine 2 to 3 , heart failure is acute on chronic  , at that time trop i is normal 0.1 ng/ml and Nt pro BNP test was > 3,500 pg/ml (normal = 450 pg/ml) , htn was also diagnosed , ct lung was done 

In MARCH he complained of loose stools and vomitings and when serum creatinine checked it turned out to be 4 

On APRIL 22 nd he again complained of sob and admitted in hospital and then serum creatinine was 5-6 , 2 tumes hemodialysis done

On APRIL 27th pt came to our hospital for financial reasons and also presented with grade 4 sob , with decreased urine output and bp measuring 220/100, we managed by giving NTG , NIV and HEMODIALYSIS was done

GENERAL EXAMINATION: 

Pallor - present , no icterus , cyanosis, clubbing , lymphadenopathy , edema present (non pitting b/l lower limbs)

Temp : 98.6 f

Pr :110 bpm

Bp:220/100 mmhg

Spo2: 98%on 4 litres o2

SYSTEMIC EXAMINATION :

RS : Bilateral air entry present , normal vesicular breath sounds , 

 

P/A : soft , non tender , bowel sounds present

 

CVS : S1 S2 present , no murmurs 

CNS : NAD

INVESTIGATIONS : 

Hemogram

ABG

Cue

Bgt

Lft , rft

TREATEMENT:

Tab.shelcal 500mg OD

Tab.OROFER XT OD

Tab . HYDRALAZINE 12.5 MG PO/BD

TAB. ECOSPRIN AV 75/20 MG PO/HS

Tab.LASIX 40mg OD

Tab.PAN 40mg OD

Tab.MET- XL  12.5 mg PO/OD

TAB NICARDIA 10 MG PO/ TID

Inj.ERYTHROPOIETIN 4000U weekly once

Inj.IRON SUCROSE 100mg weekly once in 100 ml NS

SALT AND WATER RESTRICTION