SHIVANI TUNIA ROLL NO 06

 Case History and Clinical Findings PATIENT CAME WITH C/O DISTENSION OF ABDOMEN SINCE 3 MONTHS C/O SHORTNESS OF BREATH SINCE 3 MONTHS C/O PEDAL EDEMA SINCE 20 DAYS HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 3MONTHS BACK THEN DEVELOPED DISTENSION OF ABDOMEN WITH SHORTNESS OF BREATH , GRADE II , INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE , NO AGGREVATING AND RELIEVING FACTORS . C/O PEDAL EDEMA SINCE 20 DAYS, B/L PITTING TYPE , EXTENDING UPTO THE KNEE C/O DECREASED IN URINE OUTPUT SINCE 20 DAYS C/O FEVER SINCE 5 DAYS ON AND OFF, ASSOCIATED WITH CHILLS AND RIGORSNO C/O ORTHOPNEA ,PND , CHEST PAIN NO C/O ORTHOPNEA , PND, CHESTPAIN ,PALPITATIONS NO C/O PAIN ABDOMEN , VOMITINGS ,LOOSE STOOLS PAST HISTORY: K/C/O CLD K/C/O T2DM SINCE 6 MONTHS AND IS ON UNKNOWN MEDICATION H/O ALBUMIN TRASFUSION DONE N/K/C/O HTN, EPILEPSY, ASTHMA, THYROID DISORDERS PERSONAL HISTORY : DIET :MIXED APPETITE :DECREASED SLEEP: DISTURBED H/O ALCOHOL INTAKE SINCE 20 YEARS EVERY DAY ABOUT -50ML NO H/O TOBACCO INTAKE NO H/

 Case History and Clinical Findings C/O ALTERED SENSORIUM SINCE 6 DAYS. PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK THEN HE STOPPED USING INJECTION MIXTARD SC/BD SINCE 3 DAYS.H/O OF IRRELEVANT TALK SINCE YESTERDAY BUT ABLE TO RECOGNISE ATTENDERS.PATIENT IS ABLE TO MOVE ALL LIMBS AND NO H/O INVOLUNTARY MOVEMENTS. H/O LOW GRADE FEVER SINCE 6 DAYS,INTERMITTENT IN NATURE,TEMPORARILY RELIEVED ON MEDICATION. NOT A/O WITH BURNING MICTURITION,COLD, COUGH,VOMITING,LOOSESTOOLS. NO C/O SOB,CHESTPAIN,PALPITATIONS,ORTHOPNRA,PND,PEDAL EDEMA OR DECREASED URINE OUTPUT. PAST H/O: H/O SIMILAR COMPLAINTS IN FEB 2022,PATIENT WAS ADMITTED IN OUR HOSPITAL AND WAS DIAGNOSED AS HHS WITH DIABETIC NEPHROPATHY. PATIENT HAD H/O HIGH GRADE FEVER WITH CHILLS FOR 4 DAYS AND H/O STOPPAGE OF OHAS FOR 3 DAYS. K/C/O DM2 SINCE 1.5 YEARS. K/C/O CHRONIC PANCREATITIS AND CHRONIC KIDNEY DISEASE SINCE 1 YEAR H/O PULMONARY TB 2 YEARS AGO,USED ATT FOR 6 MONTHS GENERAL EXAMINATION: PATIENT IS CONSIOUS NOT ORIENTED TO TIME ,P

 Case History and Clinical Findings C/O SPASM OF FINGERS OF UPPER LIMBS WITH TREMORS SINCE 3DAYS ,EXCESSIVE SWEATING AND GENERALIZED WEAKNESS SINCE 3DAYS . PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK ,THEN HE STARTED BINGE DRINKING AND SINCE 3DAYS HE DEVELOPED SPASM OF FINGERS OF UPPER LIMB WITH TREMORS . H/O SWEATING PRESENT . H/O ANXIETY IS PRESENT . NO H/O CHEST PAIN AND PALPITATIONS , ORTHOPNEA,PND NO H/O VOMITINGS,ABDOMINAL PAIN ,DIARRHEA . H/O COUGH WITH EXPECTORATION ,WHITISH IN COLOR SINCE 10 DAYS INCREASED IN SUPINE POSITION . K/C/O TOBACCO DEPENDENCY SYNDROME K/C/O DM 2 SINCE 6 YRS NOT A K/C/O HTN,CVA,CAD,TB,EPILEPSY . H/O 2 UNITS OF BLOOD TRANSFUSION H/O SURGERY FOR PANCREATITIS PERSONAL HISTORY APPETITE LOST SINCE 10 DAYS DIET MIXED BOWEL AND BLADDER REGULAR OCCASSIONAL ALCOHOLIC SMOKING TOBACCO SINCE 15 YRS WITH 10 CIGGARETES PER DAY GENERAL EXAMINATION PT IS CONSCIOUS,COHERENT ,CO OPERATIVE NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,OEDEMA VITALS TEMP : 99 F

 Case History and Clinical Findings C/O SOB SINCE 2 HRS FEVER SINCE 8 HRS RASH OVER THE ABDOMEN SINCE 3 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 2 HRS BACK THEN SHE DEVELOPED SUDDEN ONSET SOB GRADE 4 NO ORTHOPNEA/PND ,CHEST PAIN,PALPITATIONS,PEDAL EDEMA ,EXCESSIVE SEATING,GIDDINESS,WHEEZE PT IS K/C/O TYPE 1 DM ,MISSED 2 DOSES OF INSULIN 1 EP OF FEVER HIOGH GRADE A/W CHILLS AND RIGORS RASH OVER THE ABDOMEN SINCE 3 DAYS INITIALLY SMLL IN SIZE LATER PROGRESSED TO CURRENT STATE .H/O APPLYING PCM PASTE TO LESION NO H/O VOMITING,LOOSE STOOLS ,PAIN ABDOMEN,GIDDINESS PAST HISTORY : K/C/O TYPE 1 DM SINCE 3 YRS ON NPH,HAI INSULIN H/O RT HUMERUS FRACTURE ,TREATED CONSERVATIVELY NOT K/C/O HTN,ASTHMA,TB O/E PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA VITALS ; TEMP-98.8 BP-110/60 MMHG PR-158 BPM GRBS-HIGH SPO2-98 ON RA CVS :S1,S2 HEARD,NO MURMURS RS:BAE +,NVBS CNS: NAD P/A :SOFT,NON TENDER ,BOWEL SOUNDS+ DERAMTOLOGY REFERRAL DONE

 CHIEF COMPLAINTS:  FEVER AND INVOLUNTARY MOVEMENTS IN BOTH LEFT UPPERLIMB AND LOWER LIMB SINCE 2 DAYS 2 DAYS BACK 1 EPISODE INVOLUNTARY MOVEMENT IN BOTH UPPER LIMB AND LOWER LIMB WITH DEVIATION OF MOUTH 7 TO 8 EPISODES YESTERDAY 2 EPISODES SINCE MORNING C/O WEAKNESS OF LEFT UPPERLIMB AND LEFT LOWER LIMB SINCE 2DAYSSHE WAS APPARENTLY ASYMPTOMATIC 15 YEARS BACK ,AFTER WHICH SHE SUDDENLY FELL DOWN AND HAD LOSS OF CONSCIOUSNESSAND INVOLUNTARY MOVEMENTS OF LEFT UPPER AND LOWER LIMBS,FROTHING ,UPROLLING OF EYEBALLS.PATIENT HAD PAINLESS SUDDEN LOSS OF VISION IN THE LEFT EYE ASSOCIATED WITH LEFT UPPER AND LOWER LIMB WEAKNESS.AFTER SOME TIME PATIENT HYAD 1 EPISODE OF INVOLUNTARY MOVEMENTS OF BOTH UPPER AND LOWER LIMBS ASSOCIATED WITH LOSS OF CONSCIOUSNESS FOR 1 MINUTE,FROTHING,DEVIATION OF MOUTH.ON SUNDAY SHE HAD SIMILAR 3-4 EPISODES OF SEIZURES CT SCAN WAS DONE SHOWING SUBACUTE INFARCT IN RIGHT POSTERIOR PARIETAL LOBE AND RIGHT FRONTAL LOBE.NO H/O HEAD TRAUMANO H/O VOMITINGSPAST HISTORYUSED M

 C/O ABDOMINAL DISTENSION SINCE 1WEEK  C/O DECREASED APETTITE SINCE 1 WEEK  C/O DECREASED URINE OUTPUT SINCE AFTERNOON  PT WAS APPARENTLY ALRIGHT 1MONTH BACK THEN HE DEVELOPED PAIN ABDOMEN ON AND OFF , THEN HE DEVELOPED ABDOMINAL DISTENSION , WHICH WAS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE . NO H/O FEVER , NAUSEA , VOMITING ,LOOSE STOOLOS , CONSTIPATION HE HAD LOSS OF APPETITE SINCE 1 WEEK AND DECREASE IN URINE OUTPUT SINCE AFTERNOON. NOT A K/C/O DM ,HTN , ASTHMA , TB , CAD , CVA , EPILEPSY OCCASIONAL ALCOHOL INTAKE , NO H/O SMOKING .  GENERAL EXAMINATION : PT IS C/C/C, MODERATELY BUILT AND NOURISHED  NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMHADENOPATHY , EDEMA AFEBRILE  PR -120BPM  BP - 130/80 MMHG  RR - 20CPM  SPO2 - 98% AT ROOM AIR  GRBS - 108MG%  CVS - S1S2 HEARD , NO MURMURS  CNS-HMF INTACT . NFND  RS -BAE PRESENT , NO ADDED SOUNDS  P/A - ABDOMEN DISTENDED , UMBILICUS CENTRAL , FLANKS FULL , NO ORGANOMEGALY , SHIFTING DULLNESS PRESENT , FLUID THRILL A

PATIENT WITH C/O SOB SINCE 7 DAYS  PATIENT WAS APPARENTLY ASYMPTOMATIC 7 DAYS AGO THEN HE DEVELOPED SOB OF INSIDIOUS ONSET GRADUALLY PROGRESSIVE AND AGGRAVATED SINCE PAST 2 DAYS COUGH + WITH EXPECTORATION,BLOOD TINGED + FEVER + SINCE 7 DAYS ,LOW GRADE NOT WITH CHILLS AND RIGOR,COLDSORE THROAT -, ABDOMINAL PAIN -,VOMITING -,LOOSE STOOLS - N/KC/O CVA,CAD,TB,EPILEPSY K/C/O TB SINCE 7 YEARS AGO USED MEDICATION K/C/O HTN AND DM II SINCE 2 YEARS ON MEDICATION PERSONAL HISTORY APETITE-DECREASED SLEEP-ADEQUATE BOWEL AND BLADDER- REGULAR NO ALLERGIES  GENERAL EXAMINATION; PATIENT IS CONSIOUS ,COHERENT,COOPERATIVE  NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,EDEMA  VTALS PR-108 BPM BP- 120/60 MMHG RR-22 CPM  TEMP AFEBRILE SYSTEMIC EXAMINATION :  CVS : S1 S2 HEARD , NO MURMURS  RS : BAE +,RHONCI ?  PER ABDOMEN : SOFT , NON TENDER , NO ORGANOMEGALY  CNS : HGHER MOTOR FUNCTIONS PRESENT , NO FND  PULMONOLOGY REFFERAL DONE I/V/O BLOOD TINGED SPUTUM AND PREVIOUS TB ADVISED TRUNAAT,HRC

 PATIENT CAME WITH C/O HEAVY AND PROLONGED CYCLES SINCE 1 MONTH  PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH BACK THEN SHE DEVELOPED 1 MONTH AMENORRHEA FOLLOWED BY HEAVY AND PROLONGED CYCLE, CONTINUOUS BLEEDING FOR 11 DAYS ASSOSIATED WITH CLOTS OF SIZE 5X5 CM CHANGING 12 PADS/DAY NOT ASSOSIATED WIT PAIN THEN SHE CONSULTED PRIVATE CONSULTANT WHERE SHE PRESCRIBED T. TRANEXA 500 MG [USED FOR 3 WEEKS] AND MEORANTE 1 MG [USED FOR 8 DAYS] BLEEDING SUBSIDED AFTER USING MEDIACTION. 5 DAYS BACK PASSED CLOTS OF SIZE 3X3 CM. C/O BURNING MICTURITION SINCE 2DAYS NO H/O WHITE DISCHARGE, ABDOMINAL PAIN, DYSPARUNIA, POST COITAL BLEEDING, NO H/O STRESS INCONTINENCE NO H/O ABDOINAL DISTENSION, CONSTIPATION, DYSPEPSIA NO H/O FEVER,COUGH, COLD H/O WEIGHT LOSS SINCE 1 YR, H/O LOSS OF APPEPTITE SINCE 1 MONTH, H/O DYSPNEA ON WALKING SINCE 1 WEEK, GENERALIZED WEAKNESS SINCE 1 MONTH NO H.O WHITE DISCHARGE, ABDOMINAL  FAMILY HISTORY- NOT SIGNIFICANT ON EXAMINATION  VITALSTEMP- 97.5 F F  PR- 99 BPM RR 19 CPM  BP

 PATIENT PRESENTED TO CASUALTY WITH C/O FEVER SINCE 1 WEEK, VOMITINGS SINCE 1 WEEK( 4 EPISODES/DAY) NAUSEA PRESENT NON COMPLIANCE TO MEDICINE FOR 3 DAYS LAST WEEK AND FOR 3 DAYS THIS WEEK  HOPI: PATIENT WEAS APPARENTLY ASYMPTOMATIC 1 WEEK AGO THEN SHE DEVELOPED FEVER OF LOW GRADE WITH CHILLS AND RIGORS ,INTERMITTENT WITH VOMITINGS( 4 EPISODES PER DAY ) ,NON PROGRESSIVE ,NON BILIOUS ,CONTAIN FOOD PARTICLES AS CONTENT K/C/O DM2 SINCE 20 YEARS( USING METFORMIN 500 MG PO/OD) K/C/O HTN SINCE 20 YEARS( USING TELMIKIND 40 MG PO/OD ,NOT USING SINCE 3 DAYS)  ON EXAMINATION: PT IS C/C/C NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,LYMPHEDENOPATHY,PEDAL EDEMA VITALS: TEMP: 98.2  PR-100 BPM  BP: 140/80 MM HG  RR: 16 CPM  CVS: S1, S2+,NO MURMURS  RS: BAE +, PROVISIONAL Diagnosis  DIABETIC ACIDOSIS SECONDARY TO NON COMPLIANCE (RESOLVED) WITH AKI ON CKD SECONDARY TO LEFT HYDROURETRONEPHROSIS WITH HYPERKALEMIA(RESOLVED) WITH DILATED CARDIOMYOPATHY WITH HFMEF(EF 4%) WITH HYPONATREMIA (RESOLVED) WITH K/

Case history and clinical findings:  PATIENT CAME WITH C/O LOWER BACK ACHE SINCE 3 WEEKS RADIATING TO LEFT LOWER LIMB HOPI:PATIENT WAS APPARENTLY ASYMPTOMATIOC 3 WEEKS BACK SINCE THEN, PATIENT COMPLAINTS OF LOWER BACK ACHE WHICH IS SUDDEN ONSET,NON PROGRESSIVE,AGRAVATES ON MOVEMENT RELEIVES ON REST H/O TRAUMA(SLIP AND FALL FROM STEPS) 3 WEEKS BACK ,WAS TAKEN TO OUTSIDE HOSPITAL FOUND TO HAVE L5 BURST FRACTURE ON CT PELVIS AND CAME HERE FOR FURTHER MANAGEMENT NO H/O LIFTING OF HEAVY WEIGHTS,FEVER BURNING MICTURITION BOWEL AND BLADDER INCONTINENCE PAST HISTORY OF RIGHT PROXIMAL FEMUR FRACTURE AND DONE IMILN 10 YEARS BACK H/O PTCA DONE ONE AND HALF YEAR BACK AND IS ON REGULAR MEDICATION K/C/O DM II SINCE 20 YEARS AND IS ON T. METFORMIN 500 MG + T. VOGLIBOSE 0.2 MG + T. GLIMIPERIDE 2 MG GENERAL EXAMINATION:   PATIENT IS CONSCIOUS,COHERENT AND CO OPERATIVE NO SIGNS OF PALLOR,ICTERUS,CLUBBING,CYANOSIS,EDEMA AND LYMPHADENOPATHY VITALS: TEMP:AFEBRILE  BP: 110/80MMHG  PR:80BPM  RR:18CPM  SYSTEM

 Case History and Clinical Findings C/O FEVER SINCE 15 DAYS ABDOMINAL PAIN SINCCE 15 DAYS VOMITINGS SINCE 15 DAYS HOPI : PATIENT WAS APPARENTLY ASYMTOMATIC 3 MONTHS BACK THEN SHE HAD BURNING MICTURAION, FROTHY URINE,URGENCY,POLYURIA,NOCTURIA NO H/O POLYDIPSIA COMPLAINTS OF FEVER SINCE 15 DAYS, INTERMITTENT, LOW GRADE,ASSOCIATED WITH CHILLS AND RIGORS, RELIEVED BY TAKING MEDICATION EPIGASTRIC PAIN SINCE 15 DAS, SQUEEZING TYPE, TENDERNESS PRESENT, NO GUARDING, NO RIGIDITY, ASSOCISTED WITH VOMITINGS,FOOD AS CONTENT, NON PROJECTILE,NON BILIOUS,NON FOUL SMELLING, 3-4 EPISODE OF BLACK COLOURED VOMITTINGS NO LOOSE STOOLS, NO CHEST PAIN,PALPITATIONS, COUGH, COLD PAST HISTORY ; H/O OF SPLIT SKIN GRAFT FOR RIGHT DIABETIC FOOT FOR 4 YEARS BACK H/O LEFT BELOW KNWW AMPUTATION 1 YEAR BACK H/O HYSTERECTOMY K/C/O TB 5 YEARS BACK, DM SINCE 20 YEARS ON MIXTARD INSULIN 20 UNITS, HYPERTENSION SINCE 1 YEAR ON TAB TELMA 40 AND AMLO 5MG PO/OD, H/O BLOOD TRANSFUSION OF 8 UNITS PERSONAL HISTORY LOSS OF APPETIT

 Case History and Clinical Findings SUDDEN UNRESPOSIVNESS SINCE 6PM ON 27/03/23 HISTORY OF PRSESNTING ILLNESS PATIENT WAS APPARENTLY ASYMPTOMATIC 10 YEARS BACK THEN DEVELOPED GIDDINESS FOR WHICH HE WENT TO LOCAL HOSPITAL AN D WAS DIAGNOSED AS HAVING DIABETES AND HYPERTENSION ON MEDICATION SINCE THEN HISTORY OF WEAKNESS OF LEFT UL AND LL 3 YEARS AGO DIAGNOSED AS CVA 15 DAYS AGO DEVELOPED COUGH WITH EXPECTORATION WHITE IN COLOR AND BILATERAL LOWER LIMB SWELLING INSIDIOUS ONSET GRADUALLY PROGRESSIVE AND FEVER LOW GRADE ON AND OFF SINCE 15 DAYS AND DEVELOPED SHORTNESS OF BREATH EVEN AT REST FOR WHICH HE WENT TO LOCAL HOSPITAL AND GOT AND TREATED WITH ANTIBIOTICS FOR 6 DAYS AND GOT DISCHARGED ON LAMA AND PATIENT SYMPTOMATICALLY IMPROVED AND SINCE EVENING 6 PM DEVELOPED SUDDEN ONSET UNRESPOSIVNESS PAST HISTORY : KNOWN CASE OF TYPE 2 DM AND ON TAB GLIMI M2 2MG/500MG AND HYPERTENSION SINCE 10 YEARS AND ON T MET-XL 25mg/PO/OD K/C/O CVA3 YRS AGO AND ON TAB ECOSPIRIN AV K/C/O CAD PERSONAL HISTORY

 Case History and Clinical Findings 42 YR OLD MALE PRESENTED WITH WOUND OVER POSTERIOR ASPECT OF RIGHT FOOT SINCE 6 MONTHS AND SWELLING OF RIGHT LOWER LIMB SINCE 7 DAYS HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 6 MONTHS BACK HE HAD WOUND OVER POSTERIOR ASPECT OF RIGHT FOOT, DONE THE REGULAR DRESSING AT THE HOSPITAL AND GRADUALLY PROGRESSED TO PRESENT STATE AND LATER DEVELOPED SWELLING OF RIGHT LOWER LIMB BELOW KNEE SINCE 7 DAYS- INSIDIOUS ONSET, GRADUALLY PROGRESSED FROM ANKLE TO KNEE H/O PURULENT DISCHARGE FROM THE WOUND SINCE 1 DAY NO H/O TRAUMA C/O FEVER FOR 1 WEEK AND SUBSIDED 3 DAYS BACK ASSOCIATED WITH CHILLS, BODY PAINS,VOMITING(2 EPISODES/DAY) FOR 3 DAYS RELIEVED ON MEDICATION. H/O POLYURIA, NOCTURIA NO H/O POLYDIPSIA, POLYPHAGIA NO H/O BURNING MICTURITION, PEDAL EDEMA PAST HISTORY: K/C/O TYPE 2 DM SINCE 10 YEARS(TAB. METFORMIN 1000MG IN DAY AND 500MG IN NIGHT) NOT A K/C/O HTN/TB/ EPILEPSY/CVA/CAD/ASTHMA H/O HEMORRHOIDS SURGERY 10 YEARS BACK PERSONAL HISTORY: DECREASED APPETITE

 Case History and Clinical Findings PATIENT CAME WITH THE COMPLAINTS OF SHORTNESS OF BREATH SINCE 15 DAYS B/L PEDAL EDEMA AND FACIAL PUFFINESS SINCE 3 DAYS BURNING MICTURITION AND DECREASED URINE OUTPUT SINCE 2 DAYS HOPI:- PATIENT WAS APPARENTLY ASYMPTOMATIC 5 MONTHS AGO THEN HE DEVELOPED SHORTNESS OF BREATH AND VISITED A LOCAL DOCTOR AND TOOK TREATMENT THEN IT SUBSIDED NOW PATIENT PRESENTED WITH SHORTNESS OF BREATH SINCE 15 DAYS,INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE FROM GRADE 1 TO GRADE 3,ORTHOPNEA PRESENT, NO PND NO H/O CHEST PAIN, PALPITAIONS , EXCESSIVE SWEATING,GIDDINESS,VOMITING B/L PEDAL EDEMA PRESENT ,PITTING TYPE ,EXTENDING UPTO THE KNEE JOINT AND FACIAL PUFFINESS PRESENT SINCE 3 DAYS BURNING MICTURITION AND DECREASED URINE OUTPUT SINCE 2 DAYS NO H/O FEVER,COUGH,COLD ,VOMITINGS,LOOSE MOTIONS PAST HISTORY K/C/O TYPE 2 DM SINCE 6 YEARSAND ON TAB METFORMIN 500MG PO/OD K/C/O HTN SINCE 8 YEARS AND ON TAB METOPROLOL 0.25MG PO/OD H/O CVA 8 YEARS AGO?TIA TOOK MEDICATION FOR 2

PATIENT WAS BROUGHT TO CASUALITY WITH ALTERED SENSORIUM SINCE 1 DAY. PATIENT WAS APPARENTLY ALRIGHT 20 DAYS BACK THEN HE HAD ANASARCA AND AND WENT TO LOCAL HOSPITAL WHERE IT WAS DIAGNOSED AS CKD UNDERWENT 6 SESSIONS OF DIALYSIS IN THE LAST DIALYSIS PATIENT IS UNABLE TO LIFT HIS LEG ON WALK SINCE DAY ONE PT HAD IRRELEVANT TALK  PAST HISTORY: K/C/O DM 2 10 YEARS ON MIXTARD  K/C/O HTN 20 DAYS NICARDIA 20 MG  GENERAL EXAMINATION:  THE PATIENT IS CONSCIOUS, COHERENT, COOPERTIVE, WELL ORIENTED TO TIME, PLACE AND PERSON MODERATELY BUILT AND NOURISHED NO SIGNS OF PALLOR, ICTERUS, CYANOSIS, CLUBBING, EDEMA, LYMPHADENOPATHY  VITALS: TEMP: 99.7 F  PR: 100 BPM  RR: 20 CPM  BP: 90/60 MM HG SPO2: 95% @ RA  GRBS: 113 MG/DL  CVS: S1,S2 HEARD, NO MURMURS  RS: NVBS  PA: SOFT AND NON TENDER  CNS: NFND  OPHTHALMOLOGY REFERRAL WAS DONE ON 25/07/2023 I/V/O RAISED ICT CHANGES AND THEY EVALUATED THE CASE AND GAVE THE IMPRESSION THAT THERE WAS NO RAISED ICT OR DIABETIC RETINOPATHY OR HYPERTENSIVE RETINOPATHY I

Case history and clinical findings:- PATIENT CAME WITH C/O PEDALEDEMA SINCE 6 MONTHS , DECREASED URINE OUTPUT SINCE 1 MONTH , VOMITING SINCE 10 DAYS , SHORTNESS OF BREATH AND FACIAL PUFFINESS SINCE 2 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 8 MONTHS BACK THEN HIS STARTED DEVELOPING HYPOGLYCEMIC EPISODES 2 TO 3 TIMES A WEEK AND DURING THE EPISODE , PATIENT BEHAVED VIOLENTLY AND HAD ALTERED SENSORIUM ( ACCORDING TO ATTENDERS ) , VISITED LOCAL PRACTIONER AND PATIENT WAS GIVEN 25D , SUGAR LEVELS IMPROVED. PATIENT DEVELOPED PEDAL EDEMA 7 MONTHS AND REPEATED EPISODES OF HYPOGLYCEMIA , DIAGNOSED WITH CKD , TREATED CONSERVATIVELY ,. PATIENT COMPLAINING OF DECREASED URINE OUTPUT SINCE LAST 1 MONTH , COMPLAINTS OF VOMITING SINCE LAST 10DAYS , NON PROJECTILE , NON BILIOUS , FOOD PARTICLE AS CONTENT , NON BLOOD TINGED . C/O SOB SINCE 2 DAYS ( GRADE 2 ) ,RELIEVED ON TAKING REST , C/O FACIAL PUFFINESS SINCE 2 DAYS K/C/O DM TYPE 2 SINCE 15 YEARS , ONINJ MIXTARD , K/C/O HTN SINCE 3 YEARS , ON TAB AMLO