A 55 years old patient came to hospital with chief complaint of Decreased urine output since 3 days

 A 55 years old patient came to hospital with chief complaint of Decreased urine output since 3 days


History of present illness:
Patient was  apparently asymptomatic from past 1 year
On date : 20/07/2021 he had sudden onset of shortness of breath (SOB) taken to hospital treated with Oxygen supply to treat SOB .
Doctors told him that elevated creatinine levels in blood and adivised him to undergo dialysis
On date : 26/7/2021 
Patient is being prepared for Cvp line he suffered cardiac arrest and resusciated .
He had 6 cycles of dialysis from 28/07/21/ to 02/08/21
After his 6 th dialysis patient is discharged from hospital . After going to home he developed decreased urine output for which he brought to us.
He is still suffering with SOB treating with oxygen supply and he is undergoing dialysis

Past History: 
Patient was alright till 1997 when he had fall from a current poll after which he had injury to left upper limb , left lower limb , and lower back for which he started using pain killers daily till 1 month back.  6 years back he started developing bilateralpedal edema in lower limb - pitting type extending upto both the knees
6 years back he also developed bilateral knee joint pain and swelling .
Patient gives history trauma 1 month back to right lower limb at ankle due to bike accident which got infected for which he was prescribed some antibiotics . Wound didn't subsided with antibiotics.
Patient is not known case of diabetes, Hypertension, Asthma, Tuberculosis, chemotherapy/radiation therapy, blood transfusion and any surgeries.

Personal History: patient is conscious ,coherent and cooperative
Occupation: mechanic
Appetite:Normal 
Diet: Mixed
Sleep:Adequate
Bowelmoments:normal
Micturition:decreased urine output
Known allergies:no
Addictions: alcoholic from 25 years

Family History:
No member of family has similar complications

Treatment history:
Patinent is not allergic to known drugs

General physical examination:
Patient looks well built and nutritious
No pallor
No cyanosis
No icterus
No generalized lymphadenopathy
No malnutrition
Oedema of legs  - present ,pitting type extending upto knee
Clubbing of fingers : present 


Vitals:
Temperature : 98 ° F
Pulse rate : 87
Blood pressure:120/70
Spo2 at room temperature: 98% on 4 liters of oxygen

Systemic examination:
Cvs-
Thrills - no
Cardiac sounds - S1 S2 Heard
Cardiac murmurs - No

Respiratory system:
Dyspnoea- no
Wheeze- no
Position of trachea - central

Abdomen :
Shape - obese
Tenderness no
Palpable mass - no

CNS
 Levels of Conciousness - concious
Speech - Normal
Cranial nerves motor and sensory system - normal
Provisional diagnosis:
AkI on CKD -analgesic nephropathy
Urinary tract infection

Investigation: 
Plasma - fasting blood sugar level
Plasma - post prandial blood sugar level
Serum creatinine 
Serum potassium
Serum phosphorous
ECG:






Treatment: fluid restrictions < 2 lits / day
Salt restrictions <2 gm/ day
Inj.piptaz -2.25 gm/ IV/ TID
Tab.Fluconazole-100mg /OD
Fluid restrictions/lit/day
Protein Powder - 2 tsp in 100 ml milk / BD

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