55M with abdominal distention since 15 days,hiccoughs since 3 days.




A 55 year old male who is a toddy collector by occupation, resident of ananthagiri came with cheif complaints of abdominal distention since 15 days,pain in the interscapular region aggravated by coughing.

Hiccoughs since 3 days,continuous,not releived on taking medication.

H/O 2 episodes of seizures

H/O altered sensorium on presentation to hospital.

Vomitings on taking food, patient has not been taking food due to this complaint.


Patient was normal 3 years back then he had  right sided femoral hernia surgery.

He developed hypertension 3 years back but did not take anty medication for 1 year.

Known case of CKD-diagnosed in ESI hospital

(Then the patient had chief complaints of swelling of feet and facial puffiness)

Patient on maintenance hemodialysis since 2 years.

Patient  is dialysed every week.

Last dialysis was done 3 weeks back.


Alcohlic since 38 years,drinks toddy everyday after collecting toddy,stopped drinking after starting dialysis.(2 years back).

 Known Hypertensive since 3 years but has ignored and not taken medication for 1 year,started taking medication for hypertension after starting on hemodialysis.

Not a known case of DM,asthama,epilepsy and other cardiovascular disorders

Personal history:

Appetite: reduced since 15 days, not taking any food since 15 days

Bowels: regualar

Bladder:burning micturition 

Family history: no similar complaints of CKD,aasthama,epilepsy,CAD

Mother and brothers are known cases of hypertension.


General examination: patient is drowsy,coherent,cooperative.

Pallor is seen

 No Icterus,Cyanosis,lymphadenopathy.

Bilateral pedal pitting edema upto ankle








Failed central line



Fistula on the forearm



Vitals:

Temperature:97.1 F

Pulse:113 bpm

Respiratory rate:12/min

BP:170/100 mm hg

Spo2:99% at RA


Systemic examination:

Cvs:S1 S2 heard, no additional murmurs

CNS: no abnormality detected.

Per abdomen: 


Inspection:distended, all quadrants of abdomen are moving equally with respiration.

Umbilicus: everted

No scars, sinuses,dilated veins all over the abdomen.no visible pulsations,no visible peristalsis.

Umbilical hernia is seen






Palpation: non tender.

 Liver and spleen not palpable. 

Abdominal girth- 97 cms 5 cms above umbilicus

92 cms at level of umbilicus 


Percussion- shifting dullness present.


Auscultation: bowels sounds- heard



Respiratory system:- B/L AE+,normal vesicular breath sounds heard.



Diagnosis: CKD on MHD with uraemiac enchephalopathy 

Treatment on day 1:

Inj.Lasix -40mg IV BD

Tab.Nodosis-500mg-PO/BD

Tab.shelcal-CT PO/BD

Inj.Lorazepam 4mg IV sos

Tab.Orofer-XT-PO/BD

Treatment on day 2:

Inj.Lasix -40mg IV BD

Tab.Nodosis-500mg-PO/BD

Tab.shelcal-CT PO/BD

Inj.Lorazepam 4mg IV sos

Tab.Orofer-XT-PO/BD


USG :


ECG:



ABG:



RFT:


CBP:


Hemogram:



Hemoglobin



Serum iron:



Serum osmolality:




CUE




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