Case 3

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome."

This is a case of 45 year male patient who is a farmer by occupation presented with chief compliant of cough,stomach bloating, pedal edema,loss of apetite, SOB,no urine output and no feaces excretion

HISTORY OF PRESENT ILLNESS:-

Patient was apparently asymptomatic 7 years back. 

 she suffered from SOB and cough for which he used prescrihed medication intermitently

Later 2mnths back in government hospital she got to know that his both the kidneys had some problem and she was diabetic, for which she used medication

 Recently 9 days  back he had SOB and cough, she developed Pedal edema pitting type,which was gradual in onset and progressive in nature . 

7 days back she got addmited to the ward where she has been given dialysis(4 times) ( 2 times per week) Symptoms subsided on dialysis. Blood transfusion was done once. 

PAST MEDICAL HISTORY:-

known case of diabetic since 2 months, 

No hypertension, 

No asthma, no epilepsy, no TB, no diabetis

Had previous eye surgery and tubal ligation. 

PERSONAL HISTORY:

Diet -mixed

Appetite :loss of appetite

Bowel & Bladder movements:complete storage of bowel since 3 days, no urine output

Sleep :adequate

Addictions: Alcoholic but stopped 2months back                              smoking (chutta) -30 years back.           

FAMILY HISTORY:-

no history of  similar complaints in the family.

TREATMENT HISTORY:-

no history of drug allergies.

GENERAL EXAMINATION:-

 patient was conscious,coherent and cooperative

Malnourished

no clubbing

No cyanosis, 

No icterus, 

No generalised lymphadenopathy

VITALS-

temperature - 93F

Pulse - 895 bpm

Respiratory rate - 18 cpm

Bp-120/80

SYSTEMIC EXAMINATION -

CVS-inspection

Chest wall is bilaterally symmetrical.

No precardial bulge

No visible pulsations, engorged veins, scars and sinuses

PALPATION

Jvp is normal

AUSCULTATION -

S1 ans s2 heard

RESPIRATORY SYSTEM:

Bilateral air entry is normal.(BAE) 

Dyspnea is absent. 

Normal vesicular breath sounds heard( NVBS).

PER ABDOMEN:-

abdomen is not tender and soft

CNS:-

patient is concious

Speech is present and normal.

PROVISIONAL DIAGNOSIS:chronic kidney disease

Investigations:-

Investigations:-

-Chronic renal failure , uremic encephalopathy.

Treatment:- 

1) Inj. Piptaz :- 2.25 g IV TID 

2)Inj.Pan :- 40mg IV OD 

3)Inj .Zofer :- 4mg IV TID 

4)Inj. Lasix :- 20mg IV BD 

5)Inj .Nodosis :- 500mg IV TID 

6) Tablet shelcal :- 500mg PO OD 

7)Tablet orofer-xt  PO OD

 Questions :- 

1) How chronic renal failure causes uremic encephalopathy ? 

2) Is alcohol intake causes encephalopathy ?