55 year old male patient with bilateral pedal edema followed by facial puffiness since 6 months

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 box is welcome. 

CASE PRESENTATION:

A 55 year old male who is a farmer by occupation came to the OPD with the chief complaints of back ache since 1 year and pedal edema followed by facial puffiness since 6 months. 

Patient was apparently asymptomatic 1 year back, then he developed backache which is insidious in onset, gradually progressive,dragging type of pain, non radiating, aggravated on doing farming activities. Initially the pain was not much bothersome so he didn't think physician's consultation but the intensity of pain increased 6 months ago so he went to a hospital in Hyderabad.There he was given medication(unknown) for the pain. Patient had episodes of pedal edema, on & off type which is followed by facial puffiness preferably in the morning, so they visited nearby government hospital where the patient and his attenders were told that it's the side effect of his diabetic medication which he has been using since 6 years and he was given treatment(unknown medication) then the pedal edema subsided. During that time he and his attenders came to know that his creatinine levels were high. So he opted our hospital 3 months back but here he was prescribed some medication(unknown) saying they will aid kidney function and reduce the creatinine levels. one and half month before patient gave history of vomitings, 3-4 episodes per day for 3 days, yellow colour vomitus, non projectile, non bilious, not associated with headache, no history of trauma, patient attenders gave history of no diarrhoea or constipation, weight loss, anorexia, blood in stools. Patient was taken to nearby local hospital,there he was treated for the vomitings and patient recovered in 3 days. Later out of interest by his son-in-law patient was probed to get the creatinine test done again to know about the condition of his kidneys and to know whether the medication are effective or not. But again the levels were high to their dismay, so they were referred to our hospital. They came for consultation 1 month back, when the tests were done patients creatinine is way too high,  so they asked him to get fistula treatment and referred to higher centres. So they again went to Hyderabad to get the treatment, but they were told that the patients veins are too thin to get the fistula treatment so they asked them to choose for dialysis and suggested they get it done in this hospital itself. So they again came to the hospital to get the dialysis done. 

Patient had undergone his first dialysis on 26th of September. And the patient was stable during and after the dialysis. 

Inestigations:

25/9/2020







Hemodialysis charting 


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