General Medicine Cases

25.C.Ruchitha Reddy

General Medicine Case 1;

 August 16 2021.

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Date of Admission:31/07/2021

A 65 years Old Female ,Who was a Agricultural labour ,Who was an occasional Alcoholic came to the casuality  with the cheif complaints of 

- STOMACH ACHE,VOMITING since 20 days.

HISTORY OF PRESENT ILLNESSES:

Based on the information given by the patient,She was apparently asymptomatic 20 days before.

Their was a suddenly onset of the stomachpain,vomiting 20 days back. Vomiting was not projectile in nature.This caused her great distress and considerably decreased her appetite. She went to a hospital in Nalgonda few days back.She was referred to Kameneni and has been admitted here on 31 st of July.

She is undergoing Dialysis (3)since then.

The Patient was diagnosed to be Anemic.

The patient is diagnosed as Hyponatremic.

HISTORY OF PAST ILLNESS;

-There is No history of tuberculosis, hypertension, Diabetes Mellitus,Epilepsy, Astama.

-There is no History of any Surgeries.

PERSONAL HISTORY:

-Diet:Mixed but she has been Obligatory vegetarian since the onset of her stomach pain.

-Appetite: Her appetite fell With the onset of stomach pain

-Sleep: Disturbed

-Bowel and Bladder Movement: Irregular

-Occasionally Alcoholic.

FAMILY HISTORY:

There is no family history of such kind of problems and apparently  there is no such issue prevalent in the  surrounding area.

GENERAL EXAMINATION:

-Patient is conscious,coherent, cooperative.

-Ectomorphic built and slightly Malnourished.

-The patient is considerably pallor.

-There was no pedal edema.

-No clubbing of feet.

-No Cyanosis.

-No Decubitus.

-Complains of skin itching.

VITALS:

-Temperature: Afebrile

-Pulse rate: 92 beats /min on palpation.

-BP:120/80mmHg.

-spo2 at room temperature: 98%

SYSTEMIC EXAMINATION:

CVS;

-s1,s2 heard,NO murmurs.

Respiratory System;

-Position of trachea:Central

-Normal vesicular breath sounds- Heard

-No added sounds.

ABDOMEN;

-On palpation there is a little Abdominal Tenderness.

CNS;

-Patient is conscious

-Speech:Normal

-Motar and Sensory system normal.

PROVISIONAL DIAGNOSIS;

Acute Renal Failure.

INVESTIGATIONS.

-There was a resolving hyponatremia in  the patient

- Her serum creatinine levels was high that is 5.7 mg/dl(Normal range-0.6 -1.2 mg /dl)

-In the bacterial culture of urine plenty of pus cells are seen

-Ecoli>10^5cfu/ml was isolated

-There is necrophilic  leukocytosis seen on hemogram.

The patient was later diagnosed with renal calculi (Nephrolithiasis).

Hemogram;

Renal Function Tests;

Serum creatinine levels;

Blood urea;

Complete urine Examination;

Electrolytes;

ABG;

Bacterial culture;

CINICAL DIAGNOSIS;

Acute Renal Failure secondary to Urosepsis.

TREATMENT;

     inj Ceftriaxazone 1 g iv/BD

     Inj Erytropoietin 4000IU sc weekly twice

     Inj Ceftriaxone 1g iv /BD

     Inj Pantop 40 mg iv /OD

     Tab Orofer BD

     Tab Nodisis 500 PO/TD

      0.9%Nacl-200ml/hr.

Discussion;

-what is the criteria of Starting Dialysis? Do patients on Dialysis urinate?

-What is the mechanism by which kidneys acquire infected?