60 year old male come to OPD with a complaints of SOB ,bilateral pedal edema decreased urin output since 10 days

A 60 year old male came to OPD with the complaint of SOB, bilateral pedal, and decreased urine output since ten days.

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Chief complaint:
A 60 year old male came to OPD with the complaint of SOB, bilateral pedal, and decreased urine output since ten days.

History of present illness: patient was apparently asymptomatic ten days back then later he noticed sob(grade 2 and grade 3)with aggravating and relieving factors
-decreased urine output

History of past Illness:
- no complaints of burning during micturition
-k/c/o- htn since 10 years
-n/k/c/o- asthma, epilepsy,cad,tb

Treatment history
-no dm
- htn present
-no cad
-no asthma
-no known relevant drug history
-no chemotherapy, radiation ,blood transfusions done.

Personal history:
Married
Appetite normal
Occupation: farmer
Mixed diet
Bowel and bladder: regular
No known relevant allergies
No addictions

Family history:
No other family member has similar complaint

Physical examination:
General examination: -no pallor
                           -no lymphadenopathy 
                                     -no icterus
                                   -no cyanosis
                    -edema of the feet is seen
Vitals:
Temp: 97°f
Pulse rate: 98/min
Respiratory rate: 22/min

Systemic examination
Cvs: -no thrills
       - nocardiac murmurs
Respiratory system: - no dyspnea
                                     -No wheeze
                       - Breath sounds- vesicular
                        
                     -position of trachea-central 
Abdomen: shape of the abdomen: scaphoid
- no tenderness
- no palpable mass
- hernial orifice normal
-no free fluid
- spleen and liver: not palpable
CNS: level of consciousness - conscious
     - Speech : normal
- No neck stiffness and no kernings sign

Provisional diagnosis:
Ckd on mhd.

Plan of care: hemodialysis
Investigations:





Treatment:
 Tab: lasix 40 mg
          Orofer
       Shelcal 500 mg
       Bio p3

Inj: erythropoietin 4000iu weekly once

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