Case reports and blogs

Doa 4/1/24 dod 19/1/24 Diagnosis HEART FAILURE WITH REDUCED EJECTION FRACTION SECOUNDARY TO CAD (EF=34%) SEVERE PULMONARY HYPERTENSION LEFT LEG DIABETIC FOOT (AMPUTATED ) ANEMIA OF CHRONIC DISEASE PRE-RENAL ACUTE KIDNEY INJURY (RESOLVING) ON CHRONIC KIDNEY DISEASE HTN SINCE 10 YR DIABETES TYPE II SINCE 3YRS LEFT LEG BELOW KNEWW STMPN DEBRIDMENT + PRIMARY CLOSURE UNDER SPINAL ANESTHESIA 2 PRBC TRANSFUSIONS DONE Case History and Clinical Findings PATIENT IS A KNOWN CASE OF GUILLATINE AMPUTATION CAME FOR CLOSURE OF FLAP PATIENT WAS ADMITTED TO THE IN GENERAL SURGERY KIMS FOR DIABEYES ULCER OVER THE LEFT 2ND TOE AND GOT THE 2ND TOE AMPUTATED ON DEC 2022 AND ADEQUATE BLOOD SUGARS CONTROLE HAS BEED DONE AND PATIENT WAS DISCHRES PATIENT HAS LOST FOLLOW UP AND FURTHER GOT ADMITTED IN GENERAL SURGERY KIMS SILENCER BURN OVER THE DORSUM OF THE FOOT ON NOVEMBER 2023 DEBRIDMENT DONE AND REFFERED TO THE NEPHROLOGY AND HE ADVISED TO DIALYSIS AND PATIENT AND PATIENT ATTENDERS WERE NOT WILLING HAD LEFT...

Doa 7/12/23 Diagnosis HYPERTENSION EMERGENCY[RESOLVED] DIABETIS MELLITUS II OLD CVA [RIGHT MCA INFARCT] DIABETIC NEPHROPATHY Case History and Clinical Findings PATIENT WAS BROUGHT TO CASUALITY WITH C/O GIDDINESS SINCE MORNING C/O SLURRING OF SPEECH SINCE MORNING PATEINT WAS APPARENTLY ASYMPTOMATIC TILL MORNING THEN HE HAD GIDDINESS WHICH WAS SUDDEN IN ONSET WHILE TRAVELLING ON BIKE PATIENT HAD WEAKNESS OF LEFT UPPER LIMB AND THEN HAD GIDDINESS SUDDEN IN ONSET NO INVOLUNTARY MOVEMENTS ,NO LOSS OF CONCIOUSNESS ,NO ALTERED SENSORIUM NO RESTRICTION OF MOVEMENTS OF EYEBALLS SLURRING OF SPEECH SINCE MORNING WITH DEVIATION OF MOUTH TOWARDS RIGHT SYMPTOMATIC TREATMENT WAS GIVEN FOR ABOVE MENTIONED COMPLAINTS IV FLUIDS -NS@20ML/HR INJ.LEVIPIL 500MG 12 HRLY INJ.PIPTAZ 2.25GM 8TH HRLY FOR 5 DAYS INJ.LASIX 20MG IV/BD INJ.CALCIUM GLUCONATE 1000MG IN 100 ML NS OVER 1 HOUR INJ.25D WITH 10U HAI IV/STAT OVER 1 HOUR INJ.HAI S/C TID 6 U-6U-6U TAB.ECOSPIRIN 150MG OD TAB.CLOPIDOGREL 75 MG OD TAB.ATORVAS 40...

Diagnosis 1. STAGE IV CHRONIC KIDNEY DISEASE SECONDARY TO DIABETIC NEPHROPATHY 2. ACUTE PULMONARY EDEMA (RESOLVED) 3. HEART FAILURE WITH MID RANGE EJECTION FRACTION 4. ACUTE ON CKD SECONDARY TO UTI SECONDARY TO ? TRANSISITIONAL CELL CARCINOMA OF BLADDER 5. K/C/O LEFT BREAST CARCINOMA S/P LEFT MASTETCTOMY WITH CRT 30 YEARS AGO 6. K/C/O ACS - CAD - TVD S/P CABG 8 YEARS AGO 7. HYPOTHYROIDISM; TYPE II DIABETIS MELLITUS; HYPERTENSION Case History and Clinical Findings PRESENTING COMPLAINTS: A 70 YEAR FEMALE HOME MAKER PRESENTED TO NEPHROLOGY OPD WITH COMPLAINTS OF DECREASED URINARY OUTPUT SINCE 10 DAYS, ANURIA SINCE 1 DAY; GENERALIZED WEAKNESS SINCE 10 DAYS; NAUSEA AND VOMITING SINCE 3 DAYS ( RESOLVED ON MEDICATIONS); DECREASED APPETITE AND CONSTIPATION SINCE 3 DAYS. HOPI A 70 YEAR FEMALE PRESENTED WITH ABOVE MENTIONED COMPLAINTS; UPON ADMISSION VITALS ARE PR 98 BPM, BP 90/60 mmHg, RR 26 CPM; SpO2 98% 6 LIT OF O2;GRBS 124 MG/DL; INITIALLY FLUID CHALLENGE WITH FUROSEMIDE WAS GIVEN, PATIENT ...

Doa 28/8/24 Dod 2/9/24 Diagnosis GTCS SECONDARY TO HYPOGLYCAEMIA ? UREMIA,ASPIRATION PNEUMONIA AKI ON CKD K/C/O EPILEPSY,CVD K/C/O HTN,DM 11 - 3YEARS POSTSEIZURE PALSY- TODDS PALSY S/P 2 SESSION OF HD ALCOHOL WITHDRAWAL Case History and Clinical Findings CHIEF COMPLAINTS: C/O INVOLUNTARY MOVEMENTS B/L UPEER AND LOWER LIMBS SINCE AFTERNOON HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC TILL TODAY AFTERNOON THEN HE DEVELOPE INVOLUNTARY MOVEMENTS IN B/L UPPER LIMBS AND LOWER LIMBS INSIDIOUS IN ONSET ,GRADUALLY PROGRESSIVE ASSOCIATED WITH DEVIATION OF MOUTH TO LEFT TONGUE BITE - + FROTHING FROM MOUTH - + NO H/O FEVER ,CHEST PAIN , PALPITATIONS,BREATHLESNESS,ORTHOPNEA,PND PAST HISTORY: K/C/O DM TYPE 2 , HTN SINCE 2 YEARS - ON UNKOWN MEDIACTION K/C/O EPILEPSY SINCE 3 YEARS ON TAB.LEVIPIL 500MG PO/OD CVA- LEFT HEMIPARESIS NO H/O CAD, ASTHMA PERSONAL HISTORY APPETITE - NORMAL BOWELS - REGULAR MICTURITION-NORMAL AT TIME OF ADMISSION : TEMP:97.6F BP: 90/60 MM/HG PR:160 BPM RR:28 CPM SPO2: 72%@RA TO 9...

Doa 24/12/23 Dod 29/12/23 Diagnosis ACUTE PULMONARY EDEMA (RESOLVED) SECONDARY TO HFMEF WITH CAD PRERENAL AKI DIABETIS TYPE II HYPERTENSION Case History and Clinical Findings PATIENT CAME WITH CHIEF COMPLAINTS OF DIFFICULTY IN BREATHING SINCE LAST NIGHT. HOPI - PATIENT WAS APPARENTLY ASYMPTOMATIC 18 MONTHS BACK THEN SHE DEVELOPED DIFFICULTY IN BREATHING WITH SWELLING OF B/L LOWER LIMBS WITH FACIAL PUFFINESS AND WAS HOSPITALIZED AND TREATED. C/O DIFFICULTY IN BREATHING SINCE 1 AM LAST NIGHT (GRADE 4 MMRC). C/O CHEST PAIN - DIFFUSE ORTHOPNOEA PRESENT, H/O PND PRESENT NO H/O FEVER, SEIZURES, VOMITING, LOSS OF CONSCIOUSNESS, PALPITATIONS, GIDDINESS, SWEATING, COUGH, COLD. NO C/O DECREASED URINE OUTPUT, FACIAL PUFFINESS, ABDOMINAL DISTENSION. PAST HISTORY: K/C/O HTN SINCE 45 YEARS USING T.OLMESARTAN 20MG BD. K/C/O DM SINCE 12 YEARS USING T.METFORMIN 500MG BD K/C/O CAD SINCE 1.5 YEAR USING CLOPIDOGREL 75MG BD NOT A K/C/O EPILEPSY,TB, ASTHMA. GENERAL EXAMINATION : PT IS CONCIOUS , COHERENT AN...

Doa 2/7/24 Dod 8/7/24 Diagnosis ACUTE KIDNEY INJURY ON CHRONIC KIDNEY DISEASE (STAGE II) BENIGN PROSTATIC HYPERPLASIA SEPTIC SHOCK SECONDARY TO UTI(RESOLVED) HOSPITAL ACQUIRED PNEUMONIA (LEFT MIDLE LOBE) K/C/O HTN SINCE 20 YEARSAND DM 2 SINCE 15YEARS K/C/O CVA SINCE 15 YEARS Case History and Clinical Findings CHEIF COMPLAINTS : C/O HICCUPPS SINCE 3 DAYS C/O VOMITINGS SINCE 2 DAYS HISTORY OF PRESENTING ILLNESS : PT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK, THEN HE DEVELOPED HICCUPPS INSIDIOUS IN ONSET, GRADUALLY PROGRESSIVE WITH MULTIPLE EPISODES OF VOMITINGS WHICH IS NON PROJECTILE,NON BILIOUS,NON BLOOD STAINED. H/O SLURRING OF SPEECH SINCE 2 DAYS H/O BED WETTING NO H/O INVOLUNTARY DEFECATION H/O HYPONATREMIA PAST HISTORY : K/C/O HTN SINCE 20 YEARS, DM II SINCE 15YEARS H/O AMPUTATION (BELOW KNEE) OF LEFT LOWER LIMB 6 YEARS AGO N/K/C/O CVA,CAD,TB,EPILEPSY ON GENERAL EXAMINATION : PT IS CONCIOUS COHERENT COOPERATIVE AND WELL ORIENTED TO TIME PLACE AND PERSON. NO PALLOR, ICTERUS, CYANOSIS,...

Diagnosis ACUTE PULMONARY EDEMA ( RESOLVING) HEART FAILURE WITH REDUCED EJECTION FRACTION ( EF: 41 %) CKD STAGE III A (EGFR- 56 ML/MIN) ANEMIA ( MCHC) SECONDARY TO CKD TINEA CORPORIS MODERATE LV DYSFUNCTION TYPE 2 DIABETES MELLITUS AND HYPERTENSION Case History and Clinical Findings PATIENT CAME WITH C/O GENERALISED BODY SWELLING SINCE 10 DAYS C/O SHORTNESS OF BREATH SINCE 10 DAYS DECREASED URINE OUTPUT SINCE 1 WEEK ANURIA SINCE 8 HOURS PATIENT WAS APPARENTLY SYMPTOMATIC 10 DAYS BACK, THEN DEVELOPED SHORTNESS OF BREATH, WHICH IS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE , GRADE IV MMRC, ASSOCIATED WITH ORTHOPNEA, NO PND. GENERALISED BODY SWELLING SINCE 10 DAYS, STARTED FROM PEDAL EDEMA, PROGRESSED TO ABDOMINAL DISTENSION AND BOTH UPPER LIMBS WITH FACIAL PUFFINESS. OEDEMA PITTING IN TYPE. NO H/O CHEST PAIN, PALPITATIONS, NO DIURNAL VARIATION, NO H/O VOMITINGS, LOOSE STOOLS H/O PIGMENTED LESIONS ON HANDS AND FEET PAST HISTORY: K/C/O HTN SINCE 1 YEAR, USED TAB. OLMEZEST BETA 2020/50 , DM...