general medicine
GENERAL MEDICINE
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 CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT
DECEMBER 2 2021
28 YEARS OLD MALE WITH URAEMIC SEIZURES CKD ON MHD WITH K/C/O HTN
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case history
a 28 year old male , sales man in clothing store by occupation ,came to the opd with
cheif complaints of -
presented to casualty with h/o seizures since yesterday night h/o seizures 3 episodes around 3 am,7am,11am each episode lasting for 3 -5 minutes associated with unrolling of eyeballs +,frothing from mouth+,no tongue bite -, no involuntary micturation-,no involuntary defecation-,no ictal cry -,followed by post ictal confusion lasting for 15 - 20 minutes
history of presenting illness -
patients was apparently asymptomatic 1 week back then had fever associated with chills no h/o nausea, vomiting, loose stool.no h/o decreased urine output pedal edema ,h/o sob since 10 days grade 2 -3, haematuria + ,frothy urine
past history -
k/c/o of ckd since february 2021 on maintainance haemodialysis since april discontinued from 19/10/21 ,htn
not a known case of dm , epilepsy , asthma , tb
personal history :
diet - mixed ,appetite -normal ,bowel movement - regular , bladder movements - irregular (decreased urine output) , addictions(alcohol and smoking) - addictions alcohol occasional
family history -
nad
on examination -
patient is concious , coherent cooperative
no pallor , icterus , clubbing , cyanosis , lymphadenopathy , edema
vitals -
temperature - afebrile
pulse rate - 88 bpm
blood pressure - 160/100 mm of hg
respiratory rate - 14
spo2 - 99 % at room air
systemic examination -
cardiovascular system : s1 and s2 heard , no murmurs
respiratory system : bilateral air entry present ,normal vesicular breath sounds
central nervous system : pt is concious speech is normal kerning sign negative neckstiffness absent power in upper and lower limb (left and right ) -5/5,tone in upper limb lower limb( left and right)-normal,
Reflexes - B T S K A P
RIGHT - 2+ 3+ - 3+ - DECREASED
LEFT 3+ 3+ 3+ 3+ - DECREASED
PLANTAR REFLEX - B/L FLEXOR
FINGER NOSE IN CORDINATION - NO
KNEE HEEL IN COORDINATION -NO
investigation -
DEATH SUMMARY
32 YEAR OLD MALE CAME WITH COMPLAINATS OF FEVER SINCE 5 DAYS WITH SOB SINCE
YESTERDAY MORNING O/E TEMP - 99 DEGREE F , BP - 110 /70 MMM HG 120 - BPM 30 CPM , SP02 - 98 % AT RA , ABG SHOWING METABOLIC ACIDOSIS WITH HIGH BLOOD SUGAR WITH KETONE BODY POSTIVE DKA WITH DENOVO DM WITH SEVERE METABOLIC
ACIDOSIS ? VIRAL PNEUMONIA ,H/O SCHIZOPHRENIA 10 YEARS ON MEDICATION
(INTERMITTENT )PATIENT IS SSTARTED ON INJ HAI 40 UNITS IML IN 40 ML NS STARTED INFUSION @ 6 ML IHR WITH IVF NS @100 ML IHR PATIENT BECAME DROWSY ,TACHYPNIC
,SP02 WERE FALLING SOWN PATIENT WAS INTUBATED AND CONNECTED WITH
MECHANICAL VENTILLATIONAND LATER PATIENT HAD SUDDEN CARDIAC ARREST
CENTRAL PULSE WAS NOT FELT CPR WAS INTIATED ACCORDING TO AHA GUIDELINES INJ
ADRENALINE WAS GIVEN .DESPITE THE ABOVE RESSUCITATION PATIENT COULD 'NT BE
REVIVED AND DECLARED DEATH AT 7 PM ON 21/12/21 IMMEADIATE CAUSE OF DEATH METABOLIC ACIDOSIS ,ANTECEDANT CAUSE DIABATIC KETOACIDOSIS WITH DENOVO DM
WITH REFRACTORY METABOLIC ACIDOSIS ? VIRAL PNEUMONIA /H/O SCHIZOPHRENIA
Psychiatry opinion done I/v/o schizophrenia
treatment given -
1 .fluid restriction (1l/day) ,salt restriction <4gm/day
2. t .nodoris 500 mg po /bd 1 --x--1
3 . t.shelcal po/od x --1--x
4.t. orofer xt po/od 1--x--1
5.inj . erythropoetein 4000 iu 8/6 weekly once
6.t .nicardia 10 mg /po/od 1--x--x if sbp >130
7. tab lasix 40 mg po bd 8am --4pm--x
8 .inj sodium bicarbonate 50 meq in 100 ml ns
9.monitor bp ,pr,rr,temp charting 6th hourly strict
10.inform sos
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