A 71 year old with hypervolemia, hyponatremia and hypokalemia

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 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 patient's 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 the comment

 

A 71 year old male patient, resident of Hyderabad, presented with chief complaints of white frothy urine since 18 days and pedal edema since 18 days.

HISTORY OF PRESENTING ILLNESS: 

Patient was apparently asymptomatic 18 days back and then he developed Pyuria which was insidious in onset and gradually progressive. He also developed pedal edema which was of pitting type since 18 days. He developed facial puffiness since 6 days. Pyuria is associated with decreased urine output since 3 days and burning micturition since 3 days. It is also associated with nocturia and constipation. 

1 month back he had a fall while walking, using a walker and sustained injuries on knees and ankle. 

2 years back he had an episode of COVID infection following which he had to be hospitalized for 16 days and get treated. 

No history of fever, loin pain. 

                            


PAST HISTORY:

No similar complaints seen in the past. Patient is a known case of Bronchial asthma since 50 years (uses salbutamol inhaler for 2-4 times a day). No history of diabetes, hypertension, tuberculosis, epilepsy, coronary artery disease and thyroid disorders.


PERSONAL HISTORY:

Vegetarian diet, appetite is normal, sleep is adequate, bowel and bladder movements are regular, urine output decreased. No known allergies. Non smoker and does not consume alcohol. 

 

FAMILY HISTORY:

No similar complaints seen in family.

 

GENERAL EXAMINATION:

Patient is conscious, coherent but not cooperative. Moderately built and moderately nourished. 

Bilateral pedal edema is present of pitting type.There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy. 

                                           



Vitals --- BP: 130/80 mmHg    PR: 92 bpm    Temp: afebrile   RR: 18 cpm

 

SYSTEMIC EXAMINATION:

Cardiovascular system: S1, S2 heard. No murmurs heard.

Respiratory system: NVBS +   BAE +

Central nervous system: No focal neurological deficits.

        Tone            R                              L

        UL                N                             N

        LL                 N                             N

        Power          R                             L

        UL                5/5                          5/5

         LL                3/5                         3/5

 

        Reflexes          B     T     K     A     P

            R                  +    ++     -      -      flexor

            L                   +   ++     -       -     flexor

         Gait: not elicited                 No cerebellar signs


Per abdomen:                                                                                                                   Inspection: Shape of the abdomen- distended uniformly, flanks-free, umbilicus in the normal position, everted and nodules present. Skin over the abdomen is normal. no dilated veins. Movements of the abdominal wall are normal.

Hernial orifice, cough impulse- umbilical hernia; present

External genitalia is normal. No tenderness on renal angle.

Palpation: All inspectory findings are confirmed. No local rise of temperature, no tenderness. Liver, Spleen and Kidney are not palpable



PROVISIONAL DIAGNOSIS:

Urinary tract infection...?   BPH...? Bronchial Asthma

 

 INVESTIGATIONS:


                                    










                                        




                                        

DIAGNOSIS:

*Hypervolemia, hyponatremia with hypokalemia secondary to nebulisation 

*Paraperesis under evaluation..?

* Cystitis with umbilical hernia; UTI

*Grade 1 fatty liver with iatrogenic cushings

*Bronchial asthma since 15 years

*Grade 1 prostatomegaly


 

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