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







 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 during the episode and was taken to hospital and his GRBS was found to be low (35mg/dl)and was kept on Iv fluids(not known )and similar episodes every month for 4 months .

Not associated with frothing from mouth and involuntary moments and then since 18 days he had episodes of fever,cough.

Fever,Low grade continuous,not associated with chills and evening raise in temperature is present,And cough with whitish sputum scanty in amount not associated with blood in sputum, 

Vomiting since 1week,1episode per day,food particals as content,came for further management.


Alcoholic(1beer/day) since 30 years stopped 4 months ago.

Smoker(Cigarette,1beedi packet/day)stopped since 4 months.

Decreased appetite since 4 months.

Weight loss since4 months.

No history of Burning Micturition or frothy urine.

K/c/o DM ,on Tab.Glimi M1/OD

Not a k/c/o HTN,Tb,epilepsy,CAD,CVA.

On presentation 


Patient is drowsy but arousable 

Not oriented to place and time.

Oriented to person.

Bp:140/80mmHg

PR:88bpm

RR:24cpm

Temp:99F

GRBS:123mg/dL

CNS: pt is not oriented to place and time.

E4V4M6

CVS:S1 and S2 are normally heard.

RS:

Bilateral basal crepitations heard.

Provisional diagnosis:

Altered sensorium secondary to ?uremia

Blood investigations shows,Normocytic normochromic moderate  anemia with Neutrophilic leukocytosis.

ABG: Severe metabolic acidosis

Urea:236mg/dl

Creat:12.3mg/dl

Sodium:130

Potassium:5.8


I session on hemodialysis was done in view of uremic encephalopathy and severe metabolic acidosis.

Postdialysis:

Pt is consious,coherent,oriented to time place and person.

GCS:E4V5M6

Urea:168mg/dL

Creat:6.5mg/dl

Sodium :136

Potassium:4.9

Chloride:98

Treatment given:

Inj Lasix 40mg/IV/BD

Inj.Human actrapid insulin/SC/TID

Tab.Orofer XT /PO/BD

Tab.Shelcal CT/PO/OD

Fluid restriction

Water restriction


Hemodialysis



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