65 yr old non diabetic lady with with h/o HTN on telmesartan can wid c/o breathlessness with slight oedema under eyelid Ind increased frequency on urination. o/e slight cough . BP -170/100 . HR -90/min ..P/A -soft .nontender. no pedal oedema following r reports. kindly suggest



I have started with TB losar h Bid TB bactrim DS Bid TB pan d Bid TB folvite TB albendazole sy ambrodil s which has given me satisfactory result now BP under control, decreased breathlessness, do I have to add anything else to above treatment

You see ,there is frank haematuria.Hb also is low.If it's painless first to r/o is RENAL TUBERCULOSIS. Yes UROLITHIASIS is a possibility. UTI,.packed cell concentrate to correct ANEMIA.

if pt is breathless, than u can give Packed cell volume infusion with diuretics. don't overload the pt. its the anemia due to which ur pt is breathless rather than due to HTn. do one 2D echo also to rule out cardiac cause. if pt is on telmisartan and BP is 170 than add chlorthalidone also

Due to HTN there is proteinuria effect on kidneys and telmisatan has bad effect on kidneys so treatment.....stop telmisatan take METAPROLOL and amlodepine for HTN,. Take high protein diet.. edema is due to hypoproteinemia.

Agree Dr. Mathew

she was on telmesartan Bid dose .... I added enam2.5mg to. morning dose 3 day back still her BP is 160/100 wid PR of 96/min

according to CBP and P.S MCHC anemia is cause of her breathelessness and facial puffyness it's mostly d/t nutritional anemia but R/O the cause for frank blood(RBC) and absent RBC cast suggest it is not glomerular cause it may be d/t 1.kidney/ureteric stone 2.shistisomiasis adv USG,TSH levels

her urine culture show only sensitive to amikacin,colistin,co-trimazole,gentamycin,torbamycin,netilmicin,nitrofurantin

org is E-coli

ECG and X- Ray chest advised.

it is htn heart disease add morning dose of loop diuretic

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