A 50yr old male farmer came to the casualty with

A 50yr old male farmer came to the casualty with

 c/o

1) pedal edema since 3 months, on and off , a/w facial puffiness

2) decreased urine output since 3 months

3) sob since 3 days grade IV

no h/o abdominal distension , loose stools, vomiting , fever , cough etc.

No Past History of HTN, DM, TB, ASTHMA , CVA ,CAD.

no significant TREATMENT HISTORY

PERSONAL HISTORY - married , normal appetite , regular bowel , normal micturation,

no alldergies , Eno known addictions.

no significant FAMILY HISTORY.

O/E pt is C/C/C moderately built and nourished , has pallor and pedal edema .

Temperature -afebrile 

PR- 100 /MIN

RR- 25 CPM

BP -160/90 mmHG 

spo2 -97 at room air

grbs- 180 mg %

CVS- s1 , s2 heard 

RS- BAE PRESENT

B/L IAA CREPTS present

ABDOMEN- NAD

CNS- NAD

PROVISIONAL DIAGNOSIS - 

CKD with ANEMIA 2° TO RENAL FAILURE (ACD) 

ACUTE ON CHRONIC HEART FAILURE 

?LEFT VENTRICLE HEART FAILURE