49F TYPE 2 DIABETES AND HTN

                                  

19/10/2026

THIS IS THE CASE OF 49F DECREASED URINE OUTPUT 2 YRS, MILD SWELLING OF BOTH FEET SINCE 7 DAYS AND BREATHLESSNESS SINCE 3 DAYS

*Age:* 49 years, F

*Occupation:* Homemaker

*C/C:*

- ↓ urine output - 2 years

- Mild swelling of both feet - 7 days

- Breathlessness - 3 days

*HOPI:*

Pt was apparently asymptomatic 8 years ago then she was diagnosed with T-2 diabetes and HTN

-> 5 years ago she developed bilateral pedal edema initially involving ankles and progressing to legs. She did not go to check up as she ignored her mild symptoms & continued household work. (Tab Telmisartan)

Swelling was insidious in onset, gradually progressive, more in evening & relieved by rest.

-> 4 years ago she noticed oliguria, progressive in nature. No H/o dysuria, hematuria, UTI.

-> 3 years ago she was diagnosed with CKD - blood test. Since then she is on hemodialysis - 18 months, 3 times/week, 4 hrs per session, through left radiocephalic AV fistula

-> Breathlessness since 3 days, gradually progressive on minimal activity (MMRC grade III) (walking) associated c orthopnea. No H/o fever, cough, chest pain, wheezing

*Notes:* serum creatinine, urea, electrolytes, diuretics - furosemide, fluids

                                         

*Past history:*

- K/C/O DM - 8 years - Metformin 500mg

- HTN - 2 years - Telmisartan

- CKD - 3 years ago, hemodialysis 18 months

- N/K/C/O TB/asthma/COPD/major surgeries

*Personal history:*

- Appetite ↓

- Diet - mixed

- Sleep - disturbed

- B & B - Bowel - reg, Bladder - oliguria (200ml/day)

- No addictions

*Family H/o:* H/o father having T2 DM

*Gen examination:* O/E Pt C/C/C well oriented to TPP

- P (+) , I/C/E/L (-)

- E (+) facial puffiness b/w pedal edema

*Vitals:*

- BP - 160/90 mmHg

- RR - 24/min

- Temp - afebrile

- SpO2 - 94% on RA

- PR - 80 bpm

*Systemic examination:*

- CVS - S1 S2 (+) no murmur

- CNS - NFND

- RS - NVBS (+) BAE (+)

- P/A - soft NT

*AV fistula (Lt) wrist:*

- Inspection: surgical scar, no prominent veins, no redness, ulceration, discharge

- Palpation: palpable continuous thrill, fistula not tender/warm

- Auscultation - bruit

*Date:* 30/10/26

*Department:* General medicine

*Follow up of CKD patient*

*Age:* 49y, F

*Occupation:* Homemaker

*Diagnosis:* Chronic kidney disease on maintenance hemodialysis with type 2 DM & hypertension.

*During follow up:*

- There is still persistent breathlessness

- Mild b/l pedal edema

- Improved urine output

- No H/o fever, chills, nausea, vomiting, muscle cramps, dizziness or hypotension during dialysis

- No bleeding, pain, swelling at AV fistula site

*Vitals:*

Parameter | Previous | Follow up

BP | 160/90 mmHg | 140/90 mmHg

PR | 80/min | 84/min

RR | 24/min | 20/min

SpO2 | 94% on RA | 97% on RA

Temp | Afebrile | Afebrile

*Examination:*

- P (+) mild

- I/C/C/L (-) 

- E (+) B/L pedal edema

*Dialysis details:*

- Pre dialysis wt - 58 kg

- Post dialysis wt - 56 kg

- Ultrafiltration volume - 2L

- Thrill - present

- Bruit - present

- Urine output - 200ml/day

- Complications - none