CHRONIC KIDNEY DISEASE CASE

CASE SCENARIO 

A 90yr old female came to the Casuality with Chief complaints of Fever since 7 days

HISTORY OF PRESENTING ILLNESS:-
Patient was apparently asymptomatic 10 days back but then she had bilateral pedal edema pitting type with fever and chills  intermittent and no evening rise in temperature she also had decreased urine output and decreased appetite since 10 days she has vomiting 3episodes 5 days back  which was non bilious and non projectile containing food particles resolved after taking medication 

CHIEF COMPLAINTS - 
    Fever -10 days 
    Decreased appetite - 10 days  
    B/L pedal edema - 10 days 
     Decreased urine output -10 days   
    Vomiting- 5 days back 

 PAST HISTORY:-                                                             
  No C/O - chest pain
  H/O- Hypertension - 2yrs on medication
                                                
Not a K/c/o Asthma,Epilepsy,Tb

TREATMENT HISTORY:-
Tab.Amlodipine5mg
            +
Tab.Atenolol50mg
PERSONAL HISTORY


 Married

Occupation - farmer

decreased appetite

Bowel - regular

Micturition- decreased

 No ADDICTIONS-

No addictions

FAMILY HISTORY

Diabetes - No

Asthma - No

Hypertension - yes

Heart disease - No

Stroke - No

Cancer -No
 
INVESTIGATIONS :-
Hemogram,Renal function test,ECG,USG abdomen,chest x-ray.

Hb:6.1

PCV:19.2

TLC:9,400

RBC: 2.08

Platelet count:2.69

Blood urea: 2.14

Serum creatinine :10.0

S.Na+:126

S.K+:5.8

S.Cl-:89

PROVISIONAL DIAGNOSIS

Chronic renal failure 
Ultrasound :-



GENERAL EXAMINATIONS



 No-

Icterus/Cyanosis/Lymphadenopathy/Malnutrition



Temperature -98.4F

Pulse rate - 82beats /min

Bp - 140/90

SpO2 - 98%

GRBS - 160 mg%



SYSTEMIC EXAMINATION
CVS:  



No Thrills

Cardiac Sounds - S1, S2 +

No cardiac murmurs







RESPIRATORY SYSTEM: 



Dyspnoea - No

No Wheezing

Position of Trachea - central

Vesicular sounds 







ABDOMEN:



Shape - Scaphoid

No palpable mass

Bowel sounds- present





CNS:



Level of consciousness - conscious

Glassgow scale -E4 V5 M6





GAIT, MUSCULO SKELETAL SYSTEM, SKIN, ENT, HEAD AND NECK - NORMAL 

PUSTULAR LESIONS SEEN IN ORAL CAVITY

PRESENT ON HARD PALATE AND OROPHARYNX

TREATMENT :-

IV fluid 20 ns  IV/BOLUS

IVF  0.9% NS 100ml/hr 

Inj.pan 40 mg IV/STAT

Inj. LASIX mg IV/STAT

Inj zofer 4mg IV/STAT

Popular posts from this blog

OSCE PREFINAL EXAMINATION

1. 𝐖𝐡𝐲 𝐛𝐫𝐨𝐜𝐚𝐬 𝐚𝐫𝐞𝐬 𝐢𝐬 𝐚𝐟𝐟𝐞𝐜𝐭𝐞𝐝 ? • Broca's area is located in the frontal lobe of the brain, specifically in the left hemisphere. It's situated in the posterior part of the frontal gyrus, which is responsible for speech production and language processing. It is supplied by the middle cerebral artery. So in MCA infarct it can affect this brocas area and can lead to difficulty in speech 2. 𝐖𝐡𝐚𝐭 𝐚𝐫𝐞 𝐭𝐡𝐞 𝐬𝐞𝐧𝐬𝐨𝐫𝐲 𝐚𝐧𝐝 𝐦𝐨𝐭𝐨𝐫 𝐚𝐫𝐞𝐚𝐬 𝐬𝐮𝐩𝐥𝐥𝐢𝐞𝐝 𝐛𝐲 𝐌𝐂𝐀 𝐚𝐧𝐝 𝐰𝐡𝐢𝐜𝐡 𝐚𝐫𝐞 𝐚𝐟𝐟𝐞𝐜𝐭𝐞𝐝 𝐢𝐧 𝐭𝐡𝐢𝐬 𝐜𝐨𝐧𝐝𝐢𝐭𝐢𝐨𝐧?  • The middle cerebral artery (MCA) primarily supplies blood to various regions of the cerebral cortex. Sensory and motor areas supplied by the MCA include parts of the face, upper and lower limbs, and areas involved in sensory and motor functions. The specific regions can vary among individuals, but generally, the MCA contributes to the blood supply of the lateral convexity of the cerebral hemisphere. ...
Read more

65 yr old female cva case

Image
This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan. Patient and his/her attenders have been informed and their consent has been taken. A 65 yr old female was brought to the casualty with  complaints of  • Difficulty in moving upper limbs and lower limbs since 3 ...
Read more