NSAIDS INDUCED NEPHROPATHY WITH METABOLIC ACIDOSIS WITH CKD WITH RHEUMATOID ARTHRITIS WITH K/C/O WITH HTN(1MONTH).

 65 year old male patient came to OPD with 

C/o of shortness of breath grade 2 to grade 3 according to a NYHA classification since 15 days

C/o bilateral pedal edema(on and off since 2 yrs) and complain of decreased urine output since 2 months 

C/o decreased appetite

65 year old male who is farmer by occupation 

 was apparently asymptomatic 14 years back doing all his routine activities and then he met with an RTA and sustain low back ache for which he was conservatively treated for six days and then discharged which is followed by recurrent back ache for which he took NSAIDS for 10 years in nearby hospital followed by herbal medication .

Two years back he noticed bilateral pedal edema and went to local hospital and treated conservatively and then pedal edema is on and off.

2months back he noticed decreased urine output

Since 15 days he complain of shortness of breath grade 2 to grade 3

K/c/o Hypertension since 1month ( on tab atenolol 10mg,irregular medication)

Not a k/c/o diabetesmellitus,asthma,epilepsy,CAD .

Personal history : 

Diet - mixed 

Appetite - decreased

Sleep - adequate 

Bowel movements : regular .

Bladder movements : decreased urine output

Vitals:

Temp- 97.7 F

PR- 112

RR-20

BP-150/80mm of Hg

SPO2- 97 at room air

CVS: S1,S2 heard 

RS: BAE +,NVBS 

P/A: soft , NonTender

Bowel sounds heard

CNS : pt is conscious,coherent,cooperative,NAD.

DIAGNOSIS:NSAIDS INDUCED NEPHROPATHY WITH CKD WITH METABOLIC ACIDOSIS WITH RHEUMATOID ARTHRITIS WITH K/C/O HTN(1MONTH)

Treatment:

Fluid restriction (<1l/day)

Salt restriction (<2g/day)

INJ· LASIX 40 mg IV/ TID.

T. NODOSIS 500 MG PO BD

T. OROFER-XR PO OD

T. SHELCAL-CT PO OD

STRICT I/O MONITORING.

 

http://httpmedicin.blogspot.com/2021/12/nsaids-induced-nephropathy-with.html

Soap notes 

23/12/21

CKD ward:65 YR OLD MALE 

S:

C/o pain in bilateral lower limbs., 

C/0 neck pain

C/0 reduced appetite

Fever spikes +

B/L Pedal edema +

O:

Pt is c/c/c

Bp:160/70mmhg

PR: 78bpm

Temp: 99F

K/c/o HTN since 1month.

A:

CKD secondary to ?NSAID abuse,?NSAID induced nephropathy,with rheumatoid arthritis, K/c/o HTN since 1 month.

P:

Underwent 5 sessions of hemodialysis

On 9/12/21, 10/12/21, 13/12/21, 16/12/21, 22/11/21.

1.FLUID RESTRICTION 2L/DAY,

SALT RESTRICTION 2G/DAY.

2. TAB.NODOSIS 550 MG/PO/BD 

3..TAB.SHELCAL 50P MG/PO

4. TAB PCM 650MG/PO/BD.

5. TAB ULTRACET PO/QID 

6.Tab Methotrexate 7.5mg weekly once 

7. Tab Folic acid 5mg on every alternative day 

8. INJ.NEOMAL 1 GM/IV IF TEMP > 101.1 F

9. Inj. Erythropoietin 4000 IU - WEEKLY ONCE

10. MONITOR VITALS AND URINE I/O.

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