A 65 year old male with decreased urine output

 A 65 year old male resident of Bhongir who was farmer by occupation came with chief complaints of deceased urine output since 15 days and facial puffiness bilateral pedal edema since 15 days


HOPI 

Patient was apparently asymptomatic 3 years back.

Then a road accident occurred and got injured on his left thorax for which he took medication and diagnosed with hypertension

Then 1 yr back he had wound and it was not healing for which he went to aRMP doctor and was diagnosed with Diabetes mellitus for which he is on OHA.

He also had puffiness of face on and off since 1 year for which he visits the rmp and takes medication

Then now since 15  days he had decreased urine output (1 or 2 drops) and facial puffiness since 15 days  

He also had bilateral pedal edema (pitting) since 15 days and abdominal distension

5 days back he had an episode of vomiting and shortness of breath (grade 1) when he visited the AIIMS bhongir.

Then on 5 /08/2022 he came  our hospital

PERSONAL HISTORY

Diet mixed

Appetite Decreased

Bowel no stools since 15 days 

Bladder decreased urine output

Addictions occasionally alcohol

FAMILY HISTORY No significant family history

DRUG HISTORY No allergy to any kind of drugs


GENERAL EXAMINATION


 Patient was conscious coherent and cooperative


Moderately bulit and nourished


Pallor - present 


No Icterus , Clubbing, Cyanosis, Generalised lymphadenopathy


Bilateral pedal edema present pitting type


Vitals:


Temp:Febrile


Pulse rate: 90 bpm


Blood pressure:160/90


Respiratory rate: 20 cpm


GRBS:120mg/dl


SYSTEMIC EXAMINATION


RESPIRATORY SYSTEM EXAMINATION 


Inspection:


Symmetrical chest seen


No scars and sinuses 


Trachea central


Palpation:


Inspectory findings are confirmed


Percussion: 


Resonant note present in all lung areas


Ascultation:


Breath sounds heard. 


CENTRAL NERVOUS SYSTEM EXAMINATION 


HMF intact


Cranial nerves intact 


No focal neurological defecits 


PER ABDOMEN 


Inspection: 


No abdominal distension


No scars, sinuses, mass visible


Slit is everted


Palpation:


Inspectory findings are confirmed 


No local rise of temperature


Tenderness absent


Fluid thrill absent


Percussion:


Shifting dullness absent


Auscultation


: Normal bowel sounds heard


No bruit heard


CARDIOVASCULAR SYSTEM EXAMINATION 


Inspection : Bilaterally symmetrical chest present 


No scars, sinuses




Palpation:


Inspectory findings are confirmed


Apex beat normal


On Auscultation : 


S1 S2 heard


No murmurs or additional heart sounds


CENTRAL NERVOUS SYSTEM EXAMINATION 


Higher mental functions intact 


Cranial nerves intact 


No focal neurological defecits  

















INVESTIGATION 










 





 





DIAGNOSIS 

Acute kidney injury (Post renal)?

TREATMENT


On 5-8-2022:


Inj. LASIX 40mg I.v Stat.


On 6-8-2022:


Tab. NADOSIS 500mg P.o BD


Tab. SHELCAL P.o OD


Inj. 3%NaCl at 8ml/hr on flow.



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