CHRONIC RENAL FAILURE SECONDARY TO T2 DIABETES AND HYPERTENSION.



This is online E-blog, to discuss our patient de-identified health data shared after taking her guardian's signed informed consent.




Here we discuss our individual patient problems through series of inputs from  available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.




This E-blog also reflects my patient's centred online learning portfolio.  

A 64yr old male presented to casualty with generalised oedema, decreased urine output, Shortness of breath since 10 days 

HOPI:

He was apparently assymptomatic 4 years back, had  history of pain abdomen and abdomen tightness and was brought to hospital, diagnosed with renal calculi and underwent PCN in our hospital and was discharged in 3-4 days 


Two years back he developed neck pain and generalised weakness and went for checkup for which he  was diagnosed to be diabetic and hypertensive and on irregular medication 


He had another admission around November of 2020 on being unresponsive and was in ICU for 4-5 days diagnosed to be hypoglycaemic and on OHA’s labs showing creatinine of 5.94 and was advised for dialysis and on refusing was discharged 


He had on and off pedal oedema with no history of decreased urine output, hematuria, frothy urine or lower urinary tract symptoms 


10 days back he had history of fever with loose stools with decreased urine output for one day and anuria for 3 days and was taken to local hospital and underwent 4 sessions of hemo dialysis ( creating 12.1 ) on economic constraints he was referred to our hospital for further management 

ADDICTIONS:

He has an occasional intake of alcohol( monthly once or twice ) and smokes tobacco pipe daily for the past 10-15 years 

GENERAL EXAMINATION:

On admission 

Pallor + 

Anasarca +

Pitting type 

No Icterus,cyanosis,clubbing and lymphadenopathy 

JVP:not elevated 












Bp : 150/80mmhg,in left arm in sleeping position 

PR:98bpm

RS:Bilateral air entry present

Normal vesicular breath sounds present 

Bilateral inspiratory crepts are present in basal areas 

CVS:S1 and S2 are present 

CNS:NAD

INVESTIGATIONS:


















 

Comments

Post a Comment

Popular posts from this blog

RISK FACTORS, CLINICAL SPECTRUM, DIAGNOSTIC AND OUTCOME PREDICTORS OFPATIENTS WITH ENCEPHALOPATHY

  Altered sensorium   https://madupusanthoshini82.blogspot.com/2023/08/a-45-yrs-old-male-patient-with-altered.html https://vaishnavimaguluri.blogspot.com/2023/07/62y-male-with-pedal-edema-since-6.html 50F altered sensorium blog https://manaswinibhootharaju153.blogspot.com/2023/02/88-yrs-old-female-came-to-casualty-with.html https://srinithya27.blogspot.com/2023/02/70yr-old-male-with-altered-sensorium.html.      https://abhignya83.blogspot.com/2023/02/35-yr-old-male-with-altered-sensorium.html.  http://marisatejaswini.blogspot.com/2023/02/70f-with-altered-sensorium-secondary-to.html.  https://nehareddygaddam.blogspot.com/2022/10/80yr-male-with-altered-sensorium.html https://manogna33.blogspot.com/2022/11/44-year-old-male.html http://abhirambhashyakarla.blogspot.com/2022/11/a-case-of-78-year-old-female-with_25.html http://pranaykumar32.blogspot.com/2022/11/a-65-year-old-male-patient-farmer-by.html https://prasannaengala2799.blogspot.com/2023/02/88-yrs-old-female-came-to-casualty-with.htm
Read more

47M with Altered sensorium secondary to Uremic with Diabetes since 10years and Ckd since 1 years

Image
 A 47 years old male who is a Mason,by occupation resident of lakkaram ,Choutuppal,married 30 years ago to a agricultural labourer,both resides in lakkaram,who used to go to work from 9 to 6pm,was apparently assymptomatic 10 years ago,and then he had nocturia for 1 week(Wakes up 3-4 times/night,and his wife observed ants 🐜 on his urine and thought that he is having diabetes)and got tested and was known to be having diabetes and was on OHA since then. And on regular checkup for every 6mnths,and since 5mnths he had episodes of increased sweating once in every 1month,the first episode was 5 mnths ago where his wife saw him sweating excessively and made him to take buttermilk and used to resume his work after 5-10 minutes,no history of palpitations and chestpain at that time,and 4 months ago he had an episode of irrelevant talk and not oriented to time and place,and had tonic posture of upperlimbs and lowerlimbs for 1 hour associated with up rolling of eyeballs and increased sweating duri
Read more

Thesis and blogs

 RISK FACTORS, CLINICAL SPECTRUM, DIAGNOSTIC AND OUTCOME PREDICTORS OF PATIENTS WITH ENCEPHALOPATHY BY     DR. HARI PRIYA POST GRADUATE IN GENERAL MEDICINE DEPARTMENT KAMINENI INSTITUTE OF MEDICAL SCIENCES KALOJI NARAYANA RAO UNIVERSITY OF HEALTH SCIENCES   Loading… INTRODUCTION •ENCEPHALOPATHY is a broad term for any diffuse disease of the brain that alters brain structure or function. The hall mark of encephalopathy is altered mental status. •Encephalopathy may be caused by bacteria, virus, or prion, metabolic or mitochondrial dysfunction, ischemic or hypoxic ,brain tumour or increased intracranial pressure, long standing exposure to toxic substances like  drugs, radiation, solvents, paints, industrial chemicals, and certain metals, trauma,  poor nutrition, or lack of oxygen or blood flow to the brain.     •In febrile illness, multiple pathogenic mechanisms can contribute to the encephalopathy. Pathological process can directly affect the central nervous system or indirectly affectin
Read more