A 53 yr old came to opd with cheif complaints of bilateral edema since 10 days, shortness of breath since 4 days , decreased urine output,facial puffiness and loss of appetite since 2 days













HISTORY OF PRESENT ILLNESS: 

C/o B/L pedal odema since 10 days
SOB since 4 days
Decreased urine output
Facial puffiness since 2 days
Loss of appetite since 2 days



HISTORY OF PAST ILLNESS

known case of HTN  since 1 1/2 yearand DM since 3 years.
Alcoholic but stopped 3 years back


GENERAL EXAMINATION:

pallor 
No cyanosis
No clubbing 
No icterus
Bilateral pitting edema
Vitals:
Temp 97.5 F
Pulse rate: 98/min
RR: 27/min
Bp: 160/90mm Hg
Spo2 98%

SYSTEMIC EXAMINATION

CVS: NO thrills 
          No cardiac murmurs
 
RESP: Dyspnoea is present grade2-4
           Wheezing present
            Position of trachea - central


ABDOMEN: distended
                     No tenderness
                     No palpable mass
                     Free fluid is present
                     Liver and spleen not b                               palpable
                      Bowel  sounds are present
                      Scrotal swelling is present

CNS:

         conscious ,coherent 
         Speech normal      
         
        Cranial nerve,motor system and              sensory   system - MAD


PROVISIONAL DIAGNOSIS:
                           Right heart failure with decreased ejection fraction secondary to chronic kidney disease.


    
     PULMONARY OEDEMA


TREATMENT:



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