21 yr old man presented with abdominal tightness since 10 days,facial puffiness and pedal edema since 1 day....

21year old Man from singaram who is an autodriver came with chiefcomplaint of Abdominal tightness since 10days and went to local hospital and was kept on T.Dytor plus 10/50mg,Abdominal tightness and edema was relieved after using medication, after 1week of hospital stay.scrotal edema is present on and off.
since yesterday morning, patient observed facial puffiness from early morning and subsided as day goes on.
since today morning patient observed pedal edema,pitting type grade 2(upto shin surface)
No c/o sob,orthopnoea,PND,no c/o chest pain, palpitations,syncopial attack,No c/o abdominal pain,burning micturition,no c/o constipation and diarhoea.
At the age of 1 year,pt had h/o sob,wheeze present, where there parents took him to local hospital for which they adviced some medication(inhalers? asthma)
seasonal complaining of sob present(winter season),used medication for 3 years.
No h/o HTN,DM,TB,Epilepsy,cva,CAD
family h/o father had CKD diagnosed in 2014.
G/E
Pt is conscious, coherent and cooperative
palor +
icterus -
cyanosis-
clubbing-
lymphadenopathy-
odema+
vitals:
Temp: afebrile
Pr:131bpm
Bp:140/80mmhg
Rr:16cpm
spo2:98Percent at room air.
CVS examination:

JVP is raised.
s1s2 +,s2 wide,fixed and split
parasternal heave +,with tapping apex beat
apex beat present in 5th ICS

RESPIRATORY SYSTEM:
trachea is central in position,
BAE+
NVBS+

abdomen is distended
CNS:NAD

Provisional diagnosis. - Right heart failure secondary to? PAH with pre renal AKI, Hyponatremia secondary fluid overload

Day 1



Treatment:
1.Fluid restriction<1.5L/day
Salt intake<2gm/day
2.Inj.Lasix 40mg/IV/stat 
3.T.Pan 40mg/od
4.Inj.Thiamine 100mg in 100ml NS iv TID
5.T.Dytor 10mg/Bd

Day 2
No fever spikes
Edema subsided,pt subjectively feeling better
Treatment:
1.Fluid restriction<1.5L/day
Salt intake<2gm/day
2.Inj.Lasix 40mg/IV/stat 
3.T.Pan 40mg/od
4.Inj.Thiamine 100mg in 100ml NS iv TID
5.T.Dytor 10mg/Bd
6.Tab.Enalapril 2.5mg Po/OD

Day 3:

1.Fluid restriction<1.5L/day
Salt intake<2gm/day
2.Inj.Lasix 40mg/IV/stat 
3.T.Pan 40mg/od
4.Inj.Thiamine 100mg in 100ml NS iv TID
5.T.Dytor 10mg/Bd
6.Tab.Enalapril 2.5mg Po/OD

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