60 years old female came to OPD with chief complaints of SOB,loose stools,vomitings and for followup Dialysis

A 60 year old Female,a resident of Choutuppal presented to OPD with
CHIEF COMPLAINTS: 
SOB since 8days and pedal edema since 8days,vomitings and loose stools from 2days

History of Present Illness: 
Patient was apparently asymptomatic 8 days back then she developed shortness of breath since 8 days (insidious in onset and gradually in progression, associated with orthopnea,not associated with wheeze)
Later, she developed pedal edema (insidious in onset and gradually in progression and extended upto knee,which is pitting type (which was subsided after dialysis)
history of loose stools(4-5)episodes(mucoid and foul smelling) since 2days, 
history of vomiting since 2days(non projectile and non billous in nature)
No history of fever, headache, abdominal pain, burning micturition

PAST HISTORY:
History of HTN and CKD since 6 years for which she was on medication
History of DM (she got to know on 9/6/22)
No history of asthma, thyroid abnormality, epilepsy

TIME LINE OF ILLNESS:
PERSONAL HISTORY:
Diet: mixed
Appetite: lost
Sleep: adequate
Bladder movements: regular
Bowel movements: loose stools (4-5) episodes 
Addictions: has an habit of smoking beedi's and toddy drinker(occasionally)

SYSTEMIC EXAMINATION:
Patient is conscious, coherent, cooperative and well oriented to time and place and person
Patient is thin built and nourished

VITALS:
BP: 80/60MMHG
PULSE RATE: 59 BPM
RR: 30 CPM
TEMP: Afebrile

Pallor: present





Icterus: absent
Cyanosis: absent
Clubbing:absent
Lymphadenopathy: absent
Pedal edema: present extended upto knee, pitting type (got subsided after dialysis)


SYSTEMIC EXAMINATION:
CVS:S1 and S2 are heard

RS: Normal vesicular breath sounds are heard

CNS:no focal neurological deficit

Abdomen:
On Inspection: scaphoid abdomen,no engorged veins
On Palpation: no tenderness present 
On Auscultation: bowel sounds were normal 

INVESTIGATIONS:











Provisional Diagnosis:
CKD on MHD with Hypotension

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