Acute kidney injury

A 57 year old male resident of gopalpally farmer by occupation came to OPD with
cheif complaints of
- bilateral leg swellings since 7 days 
-decreased urine output since 2 days
 -excess sweating since 4 hours . 



HISTORY OF PRESENTING ILLNESS-

-Patient was apparently asymptomatic 15 years back then developed polyuria and polyphagia and diagnosed with Diabetes mellitus and he is on oral hypoglycemic drugs . 

- 5 years back he developed right arm and leg paralysis then he was diagnosed with Hypertension and now he is on metXL- 25.

-  He had bilateral pedel edema upto knees , facial edema since 7 days

-  H/O hand swelling since 6 days
- H/O decreased urine output  and  burning micturition since 2 days
-  H/O  shortness of breath since 1 day ; which is not associated with cough , aggrevated on walking , relieved on rest.[Grade 1/2]


PAST HISTORY - 


- He is known case of Diabetes since 15 years ,
(GluconormPG1 metformin + glimiperide + pioglitazone ), 
- Hypertension since 5 years(metXL 25mg) 
- Not a known case of TB, epilepsy, asthma 
- No history of previous surgeries 





PERSONAL HISTORY -

-He wakes up at 4:30 am then he goes to his farm do agriculture work 
-Then after 1 hour he comes to home and have tea and then goes again for the work 
- then comes in the afternoon and have lunch ( rice and dal ) 
- for dinner also he will have rice 
-Appetite is decreased
- Sleep is adequate
- Bladder - decreased urine output since 2 days 
- Bowel movements - regular 
- Addictions - consumes alcohol 
  since 40years -Full bottle daily 
  Since 2 months  - quarter
  H/O smoking 25 years ago
 Presently he quitted smoking

GENERAL EXAMINATION - 

-Patient is conscious, coherent and cooperative and Well oriented with time , place and person .
-He is well built and nourished 
-No signs of pallor , icterus , cyanosis , clubbing , generalised lymphadenopathy .
-He is having bilateral pedal edema , pitting type since 7 days .


VITALS :

-Temperature : 94.6°F
-PR:102bpm 
-RR:16cpm
-BP:190/120mmhg 
-SpO2 :96%
-GRBS : 55mg%
SYSTEMIC EXAMINATION:



ABDOMEN:


INSPECTION :
Shape of abdomen- Obese.
Scar present. 
No engorged veins.
Hyperpigmented spots on Right Side of abdomen

PALPATION :
No local rise of temperature .
No tenderness .
No palpable mass.
Liver and Spleen - Not palpable .


PERCUSSION:

Normal liver span.
Tympanic note heard over stomach region .

ASCULTATION:

Bowel sounds heard.

 



PROVISIONAL DIAGNOSIS :
Acute kidney injury secondary to
  ? Diabetic nephropathy 
  ? Nephrolithiasis 
Recurrent hypoglycemia secondary to ? OHA 

Treatment:

1.Inj.25%D infusion@50ml /hr
2.IVF NS @urineoutput +30ml/hr
3.inj.LASIX 40mgIV BD
4.tab.NICARDIA 20mg BD
5.tab.ARKAMIN 0.1mg TD
6.tab.NODOSIS 500mg BD
7.tab.SHELCAL 500mg OD
8.tab.bioD3 weekly
9.tab.MET XL 25mg OD
10.inj.MEROPENUM 500mg IV/BD
11.inj.BICARB 50meq IV/BD

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