65 year old male patient with sob

NSAIDS INDUCED NEPHROPATHY WITH METABOLIC ACIDOSIS WITH CKD WITH HTN(1MONTH).

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 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.







Lumbo sacral x ray Ap &Lateral view taken on 01-02-21.


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