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
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
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