75/M with Uremic Encephalopathy with AKI on CKD

 

MEDICINE CASE DISCUSSION

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August 05, 2021

UREMIC ENCEPHALOPATHY WITH AKI ON CKD WITH THIRD DEGREE HEART BLOCK

 CASE SCENARIO:

A 75 year old male patient came to  the casuality in unresponsive state since 1 hour.

Patient was having fever since 10 days .

HISTORY OF PRESENT ILLNESS:

The patient was apparently asymptomatic 10 days back then he had insidious onset of fever, low grade intermittent, relieved with medication, not associated with any chills and rigors.

Yesterday morning he woke up, did his routine works and was normal till evening and went to sleep but when they tried to wake him up, the patient was unresponsive.

4 months back the patient's wife demised and from then he was not interacting actively with his family members and was sleeping excessively. 

Patient had h/o left sided scrotal swelling since 6 years

 No h/o headache, vomiting 

HISTORY OF PAST ILLNESS:

No h/o diabetes, HTN, Asthma, TB and epilepsy 

PERSONAL HISTORY 

Appetite- decreased since two months 

Sleep- excess

Bowel and bladder movements- normal and regular 

Addictions- none 

FAMILY HISTORY

Not significant

GENERAL EXAMINATION:

No icterus, clubbing, lymphadenopathy, edema, pallor, cyanosis, kolionychia

SYSTEMIC EXAMINATION:

Glasgow scale: E1,V1M1

BP-140 systolic 

PR-42/min,regularly irregular 

RR-BLAE present

CVS :

 S1S2 HEARD 

no thrills no murmurs

ABDOMEN:

Non distended

Diffuse tenderness absent 

Guarding and rigidity absent

CNS-

                      Right      Left 

Tone      UL. Hyper     Hypo 

               LL. Hypo      Hypo 

Power    UL     -              -

                LL     -              -

Reflexes-

                B-     ++         ++

                T-     ++         ++

                S-     ++         ++

                K-      +            -

                A-      -             -

                P- extensor extensor

INVESTIGATIONS:

1. ECG

2. 2D Echo

3. Chest X ray

4. KUB

5. MRI Brain

6. Ultrasound 

   7. Hemogram

  8. CUE

9. LFT

10. Serum urea, creatinine, electrolytes

11. Random Blood Sugar

12. ABG 

13. CSF analysis

14. RTPCR

PROVISIONAL DIAGNOSIS: Uremic encephalopathy with AKI on CKD with third degree heart block

TREATMENT:

Inj. MONOCEF 1gm IV/BD

Inj. PAN 40 mg IV/OD

Inj. LASIX 40 mg IV/BD

Inj. DEXA 8mg IV/BD

Tab. ALUPENT RT/OD

Strict I/O charting

BP monitoring 2 hourly

Ryle's tube feeding - 100ml milk with protein powder 2 tbsp

COURSE IN THE HOSPITAL: 

75 yr old male came to the casuality in unresponsive state since 1 hour with h/o fever since 10 days and excessive sleep since 4 months. The patient was managed conservatively. With improvement in overall condition and resolution of above mentioned symptoms pt was discharged and advised for follow up after 1 week