A 30 year male presented with c/o grade 4 SOB,fever-high grade

CKD ON MHD
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' 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.





Chief complaints:
A 30 year male auto driver by occupation presented  2days ago with c/o grade 4 SOB,fever-high grade since 5days.

HOPI:
Patient was apparantly asymptomatic 1year back and then he developed  h/o intermittent chest pain and Sob ,and was diagnosed with diabetes and HTN 1 yr ago,on irregular medication and after that did not consult the doctor.
Came to our hospital last month  with grade 4 SOB diagnosed with HFrEF,Renal failure with hypertension (?Cardiorenal) and 
Dialysed in view of acute pulmonary edema 5 times last month,creat was 5.6
And then discharged on 2/6/2022

On Saturday patient presented again with c/o grade 4 SOB,fever-high grade since 5days.

c/o SOB (post dialysis  day before yesterday pt felt better and again c/o SoB since today morning)
Fever spikes +
Known diabetic and htn on irregular medication.
General Examination:
Patient is c/c
Edema present,Bilateral pitting type of edema ,Till knees.
No pallor,icterus ,cyanosis,clubbing,koilonychia,lymphadenopathy.
No splinter hemorrhages,janeway lesions,osler nodes.
Patient is on NIV
Temp :102F
Bp: 140/100mmhg
PR : 110bpm
Spo2:80% at RA
96% with NIV
Cvs s1s2+,systolic murmur in tricuspid area,
Mitral area: continuous crepitation like sound which is increasing with inspiration?pericardial rub
Rs BAE+,B/L diffuse crepts 

At admission
Creat:11.9
Urea:185
Hb:8.9
TLC:33200
Plt:4.89
Patient was dialysed on 11/06/2022(eveng),post dialysis urea:118,creat 8.4
Cultures sent ,report awaited
Started on inj piptaz
ABG:
USG:
ECG:

Echo:



showing mitral and tricuspic vegetations
DIAGNOSIS:


CKD on MHD
HTN since 1year
DM since 1 yr
HfrEF(all chambers dilated,ef 48%)
? *Infective endocarditis*





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A 45 yr old male came with complaints of abdominal distension ,sob and swelling in both legs since one week

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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 comments on comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. Presenting complaints: A  45 years old male,resindent of kodakonla mandal,janagam district hotel server by occupantion came with complaints of abdominal distension and shortness of breath
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