60 years FEMALE WITH SOB, CAP, AKI ON CKD, MODS, HFMEF, PARAXYSMAL ATRIAL FIBRILLATION

68 year old female came with complaints of 
SHORTNESS OF BREATH since 3 days
DECREASED URINE OUTPUT since 3 days
Bilateral PEDAL EDEMA since 10 days
PAPITATIONS since 15 days

HOPI :
patient was apparently asymptomatic before 3 days then she devoloped shortness of breath , which is insidious in onset and gradually progressive and it is grade 4 in seviarity. 
Decreased urine output is gradually progressive associated with swelling of both the lower limbs 
She has also complining of similar complaints 4 years back like SHORTNESS OF BREATH, DECRESED URINE OUT PUT, PEDAL EDEMA and PALPITATIONS, for these issues she got admitted in a private hospital at Hyderabad and there they done HEMO DIALYSIS 2 tims with 1 day interwal. After Dialysis she has recovered and discharged her and advised to continue medication 
PALPITATIONS are on and off since 20 years and she feels more palpitations while lying down on right lateral side 
No history of fever, trauma, vomitings , diarrhoea, burning micturition

PAST HISTORY : 
K/C/O T2-Diabetes Mellitus since 20years on inj. Human Mixtard insulin 18U - 0 - 16U
K/C/O Hypertension on Tab. Amldipine 10 mg od
K/C/O CAD since 15 years on conservative management
K/C/O CKD on conservative management
K/C/O Hypothyroidism on Tab. Levothyroxin 150mcg
No history of TB/ASTHAMA/EPILEPSY

PERSONAL HISTORY :
Diet - mixed
Appetite - decreased
Bowel - constipation
Bladder - decreased urine out put
No addictions

DRUG HISTORY :
No known drug allergy 
FAMILY HISTORY :
 No history of similar complaints in the family 

PROVISIONAL DIAGNOSIS : 
ACUTE ON CHRONIC RENAL FAILURE
? SEPSIS
T2- DIABETES MELLITUS
HYPERTENSIVE
CORONARY ARTERY DISEASE
PARAXYSMAL ATRIAL FIBRILLATION
HYPOTHYROIDISM

LAB INVESTIGATIONS : 
CBP :
Haemoglobin - 8.1
Tlc - 4000
Neutrophils - 93
Lymphocytes - 2
Eosinophils - 1
Monocytes - 4
Pcv - 24.8
Mcv - 92.5
Rbc - 2.68
Platelets -2, 16,000

RFT :
Blood Urea - 171
Creatinine - 5.3
Na - 131
K - 4.0
Cl - 99

LFT :
Total bilurubin = 2.43
Direct bilurubin =1.23
Ast =18
Alt =24
Alp =363
Total protein =5.6
Albumin =2.8






















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