65 yrs old male patient with complaints of no urine output and shortness of breath

 "This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome

Patient came with cheif complaints of decreased urine output since 1 week and complete stoppage since yesterday and bilateral lower limb swelling and cough with sputum.

Patient was apparently asymptomatic 1 week back and then he developed decreased urine output since 2 days and no urine output since 2 days and shortness of breath since 3days and pedal edema since 1 week. 

Past history:-Patient had H/o of CKD since 2 year and H/o 3 dialysis sessions done in 2020 followed by since then on medical management.

H/o COPD  since 3 years.

O/E:- pt is c/c/c.

BP-90/60 mmHg

PR- 80 bpm

RR- 22cpm

Spo2-98%on 6L o2.

CVS-S1S2 +

RS- BAE+

CNS- NAD.

P/A - soft ,non tender




Investigations:-







Provisional diagnosis:-

Chronic kidney disease with COPD.

Treatment:-

Inj lasix 20 mg IV BD.

Inj NORAD 20ml/hr 

Inj Dobutamine 7.2ml/hr

IV fluids NS @ uo+ 50ml/hr.

Nebulization with Ipravent and budecort.

Inj optineuron 1amp  in 100 ml NS IV OD.

Tab pulmoclear 100mg po  BD

Tab orofer XT po OD

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