55 Y /M with Heart failure , ? COPD , Below kee amputation

55 Y / M pt presented to casuality with c/o 

Blurring of vision since 1 year 

Decreased urine output since 2 months 

Pedal edema since 1 month 

SOB since 3 days 

Distended abdomen since 2 days 

Pt was apparently asymptomatic 10 yrs back , then he was diagnosed with DM type 2 , on has been using Glimi 2 mg tablets 

Pedal edema was gradually progressive 

SOB grade 4 was more during the night , PND 

There are no aggregating and relieving factors 

Pt is a k/c/o DM since 10 yrs , on Tab Glimi 2 mg 

HTN since 2 yrs , on T. Telma 40 mg 

Surgical history : Pt had below knee amputation 1 yr back , due to trauma to the left lower limb which developed cellulitis 

Pt is an occasional alcoholic since 30 years 

Chronic smoker since 20 years ( daily 1 pack of cigarette and 1 pack of beedi ) 

Medical h/o : 

Pt is on T Atorvastatin 10 mg 

T Pentoxifyllin 400 mg since 1 yr 

Not a k/c/o tb , asthma 

Occupation : Mason 

Appetite : normal 

Diet : mixed 

B& B : decreased micturition 

Pallor present 

CVS: S1S2+

No murmurs 

RS: 

DYSPNEA + 

Wheeze + 

inspiratory crepts in b/l ISA , IAA , IMA 

Trachea position-central.

Vesicular breath sounds heard

 P/A: 

  Soft, non tender 

  DISTENDED 

  Bowel sounds heard .

  

CNS: NAD 

Provisional diagnosis : ? AKI with right heart failure 

? COPD , with left below knee amputation 

K/c/o Type 2 DM since 10 yrs 

HTN since 2 yrs 

Clinical images : 

Investigations : 

On 6/12/21 

USG ABDOMEN : 

2 D echo : 

ECG on 6/12/21 

ECG on 7/12/21 

On 8/12/21

S urea 169 

S creat 9.8 

Treatment : 

Fluid restriction 

Salt restriction 

Inj lasix 40 mg iv bd 

Inj HAI sc 8 am ....1 pm...8 pm

Neb with duolin 8 th hrly , budecort  12 hrly