55 yr /F with CKD

Case:
55 yr female came with 
Chief complaints :
-Bilateral pedal oedema since 2 months
-Shortness of breath since 10 days
HOPI:
Patient was apparently asymptomatic 2 months ago, then she developed bilateral pedal oedema,which is pitting type, extending upto knee .she developed SOB since 10 days , which is grade 2
Patient is on haemodialysis since 3 months
Today she had sudden onset of decreased responsiveness 
Past history:
K/C/O DM since 5 yrs and on medication
K/C/O HTN since 6 months and on medication (Nicardia 10 mg)
Personal history:
Appetite -Normal
Diet-Mixed
Bowel and bladder habits -Regular
Sleep -Adequate
Addictions - K/C/O smoker 20 beedis/ day
General Examination:
Patient is drowsy but arousable to deep pain
No pallor, icterus, cyanosis, clubbing, lymphadenopathy
Bilateral pedal oedema -present
Vitals:
PR:93 bpm
BP:130/70 mm hg
SpO2:82 on RA and 98 on 6l O2
CVS:S1S2 Present
RS:BAE Present,NVBS
P/A: Soft,non tender
CNS:E3V5M6
     POWER                 Right               Left
        UL.                   4/5.          4/5
        LL.                   2/5.          3/5
TONE.                     Right                Left
      UL.                  Normal           Reduced 
      LL.                  Normal.            Reduced
Reflexes.  B/l plantar - Mute
Investigations:
Provisional Diagnosis:Altered sensorium secondary to hypoglycemia
Chronic kidney disease with maintenance haemodialysis K/C/O  DM,HTN, Hypothyroidism,Biopsy proven diabetic nephropathy
Treatment:
1)Inj.lasix 40 mg IV/BD
2)T.Arkamine 0.1 mg PO/TID
3)T.Cilcar 10 mg PO/BD
4)T.Nodosis 500 mg PO/BD
6)T.Orofer XT PO/OD

Popular posts from this blog

57/F with low back ache

Image
Case: A 57year old female came with chief complaints of - Low back ache from 10 years -Excessive lacrimation from 10 days -Epigastric pain from 10 days HOPI: Patient was apparently asymptomatic 10 years ago , then she fell from steps and after 1 year she has back ache and went to hospital in bhopal  where she was given medications and 4 years ago she again fell on road and went to hospital in Hyderabad where she was given lumbar support belt and medications,now she came with low back ache, squeezing type , radiating to both lower limbs - Excessive lacrimation from 10 days -Epigastric pain from 10 days,burning sensation Past history: K/C/O HTN ,not on regular medication No DM,Asthma, Epilepsy,TB,CVA,CAD Present history: Appetite:Reduced Diet :Mixed Sleep : sleeplessness  at night from 6 months Bowel and bladder habits -Regular Addictions :Chews betel leaf  6-7 / day from 35 years General Examination: patient is conscious, coherent, co-operative, well oriented to time, place and person M
Read more

33 yr male with pain abdomen

Image
Case: 33 yr male came with chief complaints of  - Epigastric pain since 5 yrs HOPI: Patient was apparently asymptomatic 5 yrs ago then he developed epigastric pain he went to local hospital 5 yrs ago where he was given medication and again after 4 years he presented with loin pain went to local hospital where he was diagnosed with renal calculi and now presented with epigastric pain since 1 month ,insidious in onset ,pricking type,non radiating, reduced after taking food, burning sensation after taking spicy food,relieved after medication. -No fever , vomiting, burning micturition, diarrhoea  Past history: Not a known case of DM,HTN, Asthma, Epilepsy,CVA,CAD,TB Present history: Appetite -Nornal Diet-Mixed Sleep -Adequate Bowel and bladder habits -Regular No addictions General Examination: Patient is conscious, coherent, co-operative Well oriented to time, place and person Moderately built and nourished  - No pallor , icterus, cyanosis, clubbing,pedal oedema, lymphadenopathy
Read more

Medicine blended assignment

I have been given the following cases to solve in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and come up with a treatment plan.                                                     This is link of questions asked regarding cases: http://medicinedepartment.blogspot.com/2021/05/online-blended-bimonthly-assignment.html?m=1                                           Name: Grandhi.N.D.L.S.Srujini           Rollno:41                                                          Below are my answers for the assignment:.                                                     1) Pulmonology.                                              A)https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html Questions: 1) What is the evolution of the symptomatology in this patient in terms of an event timeline an
Read more