58 year old man with chief complaint of fever and pedal adema since 15 days

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 patients 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 comment box is welcome .

58 years old Man resident of bhongir   farmer by occupation presented to opd with chief complaint of abodminal distension

HISTORY OF PRESENTING ILLNESS
patient was asymptomatic 6months back later he developed pedal edema 
On local doctor visit reported about kidney problem 
Doctor suggested to have dialysis 
Then he had dialysis sessions for 5 months 
Then he presented to our hospital for dialysis and also with abdominal distension 

PAST HISTORY
known case of hypertension since 6months 
No diabetes

FAMILY HISTORY 
no significance

PERSONAL HISTORY
Mixed diet 
Normal appetite
Abnormal micturition 
No drug alergy 
Occasional drinker

General Examination
Pallor is seen 
No clubbing 
No cyanosis 
No icterus

ABDOMEN
shape:- scaphoid
No tenderness
No palapable mass
No fluid present
Spleen not palpable
Bowel sounds heard



Vitals 
Temp :- 98.4
Pulse:- 96 b/m
Respiration:- 18 per min
Bp :- 140/90

CNS 
Conscious, cooperative,coherent
Reflexes are normal 
No speech problems

CVS 
S1and S2 are heard
No cardiac murmurs

Provisional diagnosis 
chronic kidney disease on maintenance hemodialysis


INVESTIGATIONS

Renal function test
Urea:- #90
Creatine#6.8
Uric acid#7.9
Phosporous:- 4.8

Complete blood picture
Haemoglobin:- 11.3#
complete urine examination
ecg

Ultrasound

Clinical image of abdomen









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