55yr old M patient with AKI,?heart failure and below knee amputation

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55 yr old male patient from chikatmamidi ,mason by occupation came to the opd with the chief complaint of 

-pedal edema ,decreased appettite since 1 mnths 

-SOB since 3 days

-decreased urine output since 2 days

- fainting,wheezing sounds. 

History of present illness:-

Patient was apparently assymptomatic before 2 months back, later he slowly developed pedal edema ,decreased urine output and had fainting on nov 15th.

For which he visted the government hospital(creatinine level increased) . He was admitted for 1 week withmedications.He was informed to go for for dialysis. Later he visited the local hospital, used mediactions for 15 days, after 2 days he got fainted, heezing sounds, admitted to the hospital ,went for dialysis. 

He has thrombophlebitis on left hand since 3 days. 

 So far:- undergone 4 dialysis 

             1st -11th dec

             2nd -14th dec

             3rd-16th dec

             4th-18th dec

Post dialysis :- decresed unrine output, decreased appetite, body pains

History of Past illness:-

k/c/o DM 2 since 10 years

K/C/O HTN sice 4 years

2 years back on a small injury to foot, he developed gangrene(pus release -whitish yellow color) 

initially:- 2 toes undergone amputation 

                Later foot amputation

                Later below knee amputations

             due to spread. 

Personal history:-

Built:- ectomorphic

Appetite :- mixed

Bowel and bladder:-decreased appettite since 2 months

Urine :- decreased appetite since 2 days

Drinking:- at the age of 20 years

                 Regularly (weekly 3 times)

Smoking:- at the age of 20 years

Medical history:-

On medication for

DM since 15 years

 Brain clots:- ecospiril since 4 yrs

 HTP since 4 yrs

Amputaion since yrs

Family history:-

Mother - HTP, diabetis

Late Father-HTP,diabetis

                     Death due to CKD

One son:- congenital heart disease

One daughter:-diabetis since 4 mnths back

General examination:-

Pallor present

No cyanosis, no icterus, no lymphadenpathy 

Vitals:-

Temperature:-98.6 F

Bp:-240/130 mm hg

RR:-26 per min

Pulse rate:-102 per min 

Systemic examination:-

CVS: S1S2+

No murmurs 

RS: 

DYSPNEA + 

Wheeze + 

Trachea position-central.

inspiratory crepts in b/l ISA , IAA , IMA 

Vesicular breath sounds heard

 P/A: 

  Soft, non tender 

  DISTENDED 

  Bowel sounds heard .

  

CNS: NAD 

Clinical images:-

Investigations:-

       

Provisional diagnosis : ? AKI with right heart failure 

With left below knee amputation 

K/c/o Type 2 DM since 10 yrs 

HTN since 2 yrs 

Treatment :-

Fluid restriction <2lit/day

Salt restriction <2g/day

Inj lasix 40 mg iv bd 

Inj HAI sc 8 am ....1 pm...8 pm

Tab.nicardia 10mg od

Neb wrt duoline 8 hrly

                Budecort 12 hrly

Vitals monitoring 6 hourly

Dialysis.  

Final diagnosis:-

AKI with heart failure.