MEDICINE

72YEAR OLD MALE CAME WITH COMPLAINTS OF SOB , COUGH AND PEDAL EDEMA SINCE 10 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK THEN DEVELOPED PEDAL  EDEMA PITTING TYPE, COUGH ASSOCIATED WUTH SPUTUM (GREENISH) FOUL  SMELLING. H/O OF FEVER,COLD 1 MONTH BACK  PATIENT NOTICED WEIGHT LOSS SINCE 1 MONTH FEVER WHICH WAS INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE NOT ASSOCIATED  WITH CHILLS AND RIGOR. NO COMPLAINTS OF CHEST PAIN, COUGH, SOB ,BURNING MICTURITION , CONSTIPATION, WEIGHT LOSS, HEAD ACHE, EGIGASTRIC PAIN, BLURRING OF VISION,  PALPITATIONS, LOOSE STOOLS  K/C/O HYPERTENSIVE AND DIABETES  ON REGULAR MEDICATION. K/C/O ALCOHOLIC SINCE 10 YEARS ( WHISKEY 90ML)  PROVISIONAL DIAGNOSIS  : AKI ON CKD WITH HYPERKALEMIA 

36 YEAR OLD FARMER BY OCCUPATION CAME WITH COMPLAINTS OF VOMITINGS SINCE MORNING AND GENERALISED WEAKNESS  PATIENT WAS APPARENTLY ASYMPTOMATIC TILL YESTERDAY THEN HE HAD  VOMITINGS (10-20 EPISODES SINCE MORNING) CONTAINS FOOD PARTICLES , NON BILIOUS, NON PROJECTILE , ASSOCIATED WITH STOMACH PAIN DIFFUSE TYPE. NO COMPLAINTS OF FEVER, CHEST PAIN, COLD, COUGH, SOB ,BURNING MICTURITION , CONSTIPATION, WEIGHT LOSS, HEAD ACHE, EGIGASTRIC PAIN, BLURRING OF VISION,  PALPITATIONS, LOOSE STOOLS NOT A K/C/O HYPERTENSIVE AND DIABETES  K/C/O ALCOHOLIC SINCE 10 YEARS ( WHISKEY 90ML) CHEWS TOBACCO SINCE 10 YEARS  NO SIMILAR COMPLAINTS IN THE PAST. ON EXAMINATION : PATIENT IS C/C/C ,  MODERATELY DEHYDRATED. AFEBRILE , NO PALLOR , CYANOSIS , CLUBBING, LYMPHADENOPATHY, EDEMA ICTERUS + BP:110/80 mmhg  PR: 80bpm /regular  P/A : SOFT, NO TENDERNESS PRESNT  INVESTIGATIONS: RFT: UREA: 29 CREATININE: 1.2 CALCIUM: 10.2 PHOSPHORUS: 3.9 SODIUM: 141 POTASSIUM: 3.0 CHLORIDE: 94 SERUM LIPASE: 26IU/L SERUM AMYLASE:

1.ANATOMICAL DIAGNOSIS: LIVER? CARDIAC? KIDNEY?  ETIOLOGICAL DIAGNOSIS -  ?? NEPHROTIC SYNDROME SECONDARY TO THE  DIABETIC  NEPHROPATHY OR CKD  2) REASONS FOR:  I) AZOTEMIA : IMPAIRED RENAL EXCRETION  OF UREA AND  CREATININE SECONDARY TO CKD.   II) ANEMIA : DECREASED ERYTHROPOIETIN   III) HYPOALBUNEMIA: CAPILLARY BASEMENT MEMBRANE AND PODOCYTES DAMAGE    IV) ACIDOSIS: ACIDIFICATION OF URINE LOST.   3. RATIONALE SYRUP. POTCHLOR WAS GIVEN BECAUSE OF HYPOKALEMIA. INJ. BICARBONATE WAS GIVEN BECAUSE OF METABOLIC ACIDOSIS. INSULIN AND HYPERTENSIVES ARE GIVEN BECAUSE KNOWN CASE OF DM AND HTN.  OROFER XT WAS GIVEN BECAUSE OF ANEMIA.  INJ.LASIX WAS GIVEN BECAUSE TO DECREASE HER VOLUME OVERLOAD. SPIRONOLACTONE WAS GIVEN BECAUSE IT WAS A POTASSIUM SPARING DIURETIC. CALCIUM WAS GIVEN TO THE PATIENT BECAUSE OF HYPOCALCEMIA SECONDARY TO CKD. 4. INDICATIONS OF DIALYSIS IN THIS PT : WORSENING OF SOB SECONDARY TO METABOLIC ACIDOSIS  WITH ANURIA NOT RESOLVED WITH HIGH CEILING DIURETICS  CRUCIAL FACTOR :