C/OINVOLUNTARY MOVEMENTS ALL OVER THE BODY

 Case History and Clinical Findings

C/OINVOLUNTARY MOVEMENTS ALL OVER THE BODY SINCE 4DAYS

HOPI:

PT WAS APPARENTLY ASYMPTOMATIC ALRIGHT 7 DAYS BACK THEN DEVELOPED SOB AND HEAVENESS OF CHEST FOR WHICH HE WAS ADMITTED AND GOT TREATED THEN AFTER HE WAS DEVELOPING INVOLUNTARY MOVEMENTS OF ALL OVER THE BODY PROGRESSING IN INTENSITY

NO H/O TRAUMA TO HEAD

NO H/O INVOLUNTARY FALLS

NO H/O SPIPPAGE OF SLIPPERS

NO H/O DIFFICULTY IN COMBING,NO H/O DIFFICULTY IN CHEWING

NO H/O SQUINT,ANOSMIA,PAROAMIA,HICCUPS,DYSPHAGIA,ABDOMINAL PAIN,VOMITINGS,DIARRHOA

K/C/O AD PCKD ,TB 30 YEARS BACK

DM SINCE4YEARS ON GLIDAZIDE 80MG

HTN SINCE 2 YEARS

GENERAL EXAMINATION:

PT IS C/C/C

BP-140/80

PR-86BPM

SPO-99

SYSTEMIC EXAMINATION

CVS-S1S2+

RS-NVBS

CNS-NFND

P/A-SOFT NON TENDER


PROVISIONAL DIAGNOSIS:-

POLYCYSTIC KIDNEY DISEASE

STAGE V CHRONIC KIDNEY DISEASE

ANEMIA SECONDARY TO CKD

K/C/O PULMONARY KOCHS 30 YEARS AGO

DM+,HTN+


Investigation:-

RFT 03-01-2024 03:57:PM:-

UREA :- 252 mg/dl42-12 mg/dl

CREATININE - 11.0 mg/dl1.3-0.9 mg/dl

URIC ACID - 9.6 mg/dl7.2-3.5 mg/dl

CALCIUM - 8.1 mg/dl10.2-8.6 mg/dl

PHOSPHOROUS - 7.4 mg/dl4.5-2.5 mg/dl

SODIUM - 140 mEq/L145-136 mEq/L

POTASSIUM - 4.2 mEq/L5.1-3.5 mEq/L

CHLORIDE - 104 mEq/L98-107 mEq/L

HBsAg-RAPID - 03-01-2024 03:57:PM:- Negative 

Anti HCV Antibodies - RAPID - 03- 01-2024 03:57:PM :-Non Reactive

 COMPLETE URINE EXAMINATION (CUE) 03-01-2024 03:57:PM:- 

COLOUR:paleyellow

APPEARANCE :- Clear,   

REACTION:- Acidic

SP.GRAVITY:- 1.010

ALBUMIN+

SUGAR - Nil

BILE SALTS - Nil

BILE PIGMENTS - Nil

PUS CELLS - 2-4

EPITHELIAL CELLS - 2-3

RED BLOOD CELLS - Nil

CRYSTALS - Nil 

CASTS - Nil

AMORPHOUS DEPOSITS - Absent

OTHERS:- Nil

RFT 04-01-2024 11:42:PM:-

UREA - 258 mg/dl42-12 mg/dl

CREATININE - 11.3 mg/dl1.3-0.9 mg/dl

URIC ACID - 8.9 mg/dl7.2- 3.5 mg/dl

CALCIUM ;- 7.0 mg/dl10.2-8.6 mg/dl

PHOSPHOROUS8.9 mg/dl4.5-2.5 mg/dl

SODIUM139 mEq/L145-136 mEq/L

POTASSIUM3.9 mEq/L5.1-3.5 mEq/L

CHLORIDE106 mEq/L98-107 mEq/L

LIVER FUNCTION TEST (LFT) 05-01-2024 10:58:AM:-

Total Bilurubin0.68 mg/dl1-0 mg/dl

Direct Bilurubin0.19 mg/dl0.2-0.0 mg/dl

SGOT(AST)17 IU/L35-0 IU/L

SGPT(ALT)21 IU/L45-0 IU/L

ALKALINE PHOSPHATE - 274 IU/L119-56 IU/L

TOTAL PROTEINS - 7.0 gm/dl8.3-6.4 gm/dl

ALBUMIN - 4.23 gm/dl4.6- 3.2 gm/dl

A/G RATIO1.53

ABG 05-01-2024 02:38:PM:-

PH7.25 

PCO - 223.3

PO2114

HCO310.0

St.HCO312.6

BEB-15.5

BEecf-15.8T

CO221.5

O2 Sat97.3

O2 Count13.9


COMPLETE URINE EXAMINATION (CUE) 05-01-2024 03:27:PM:-

COLOUR:pale         yellow

APPEARANCE- Clear

REACTION - Acidic

SP.GRAVITY - 1.010

ALBUMIN - Nil

SUGAR - Nil

 BILE SALTS - Nil

BILE PIGMENTS - Nil

PUS CELLS - 2-3

EPITHELIAL CELLS - 2-3

RED BLOOD CELLS- Nil

CRYSTALS - Nil

CASTS - Nil

AMORPHOUS DEPOSITS - Absent

OTHERS - Nil

ABG 05-01-2024 05:54:PM:-

PH7.49

PCO220.1

PO2115

HCO315.4

St.HCO319.1

BEB-6.5

BEecf-7.4T

CO231.8

O2 Sat96.0

O2 Count12.4

RFT 05-01-2024 11:30:PM:-

UREA122 mg/dl42-12 mg/dl

CREATININE6.7 mg/dl1.3-0.9 mg/dl

URIC ACID4.8 mg/dl7.2-3.5 mg/dl

CALCIUM8.9 mg/dl10.2-8.6 mg/dl

PHOSPHOROUS5.5 mg/dl4.5-2.5 mg/dl

SODIUM139 mEq/L145-136 mEq/L

POTASSIUM3.2 mEq/L5.1-3.5 mEq/L

CHLORIDE102 mEq/L98-107 mEq/L

RFT 06-01-2024 11:01:PM:-

UREA78 mg/dl42-12 mg/dl

CREATININE4.8 mg/dl1.3-0.9 mg/dl

URIC ACID3.0 mg/dLl7.2-3.5 mg/dl

CALCIUM9.1 mg/dl10.2-8.6 mg/dl

PHOSPHOROUS4.0 mg/dl4.5-2.5 mg/dl

SODIUM140 mEq/L145-136 mEq/L

POTASSIUM3.1 mEq/L5.1-3.5 mEq/L

CHLORIDE98 mEq/L98-107 mEq/L

POST LUNCH BLOOD SUGAR07-01-2024 04:14:PM:-132 mg/dl140-0 mg/dl

RFT 07-01-2024 10:38:PM:- 

UREA124 mg/dl42-12 mg/dl

CREATININE7.1 mg/dl1.3-0.9 mg/dl

URIC ACID4.9 mg/dl7.2- 3.5 mg/dl

CALCIUM9.7 mg/dl10.2-8.6 mg/dl

PHOSPHOROUS5.4 mg/dl4.5-2.5 mg/dl

SODIUM140 mEq/L145-136 mEq/L

POTASSIUM3.4 mEq/L5.1-3.5 mEq/L

CHLORIDE101 mEq/L98-107 mEq/L

RFT 09-01-2024 02:48:PM:-

UREA81 mg/dl42-12 mg/dl

CREATININE3.9 mg/dl1.3-0.9 mg/dl

URIC ACID4.3 mg/dl7.2-3.5 mg/dl

CALCIUM9.9 mg/dl10.2-8.6 mg/dl

PHOSPHOROUS5.1 mg/dl4.5-2.5 mg/dl

SODIUM135 mEq/L145-136 mEq/L

POTASSIUM3.5 mEq/L5.1-3.5 mEq/L

CHLORIDE101 mEq/L98-107 mEq/L

RFT 09-01-2024 10:47:PM:-

UREA62 mg/dl42-12 mg/dl 

CREATININE4.4 mg/dl1.3- 0.9 mg/dl

URIC ACID2.7 mg/dl7.2-3.5 mg/dl

CALCIUM9.4 mg/dl10.2-8.6 mg/dl

PHOSPHOROUS4.4 mg/dl4.5-2.5 mg/dl

SODIUM136 mEq/L145-136 mEq/L

POTASSIUM3.1 mEq/L5.1-3.5 mEq/L

CHLORIDE102 mEq/L98-107 mEq/L

COMPLETE URINE EXAMINATION (CUE) 10-01-2024 12:19:PM:-

COLOURPaleyellow

APPEARANCEClear

REACTIONAcidic

SP.GRAVITY1.010

ALBUMIN++

SUGARNil

BILE SALTSNil

BILE PIGMENTSNil

PUS CELLS3-4

EPITHELIAL CELLS2-4

RED BLOOD CELLS - Nil

CRYSTALSNil

CASTSNil

AMORPHOUS DEPOSITSAbsent

OTHERS - Nil

STOOL FOR OCCULT BLOOD10-01-2024 12:19:PM-Negative (-ve)

RFT 11-01-2024 07:44:AM:-

UREA70 mg/dl42-12 mg/dl

CREATININE4.6 mg/dl1.3-0.9 mg/dl

URIC ACID4.4 mg/dl7.2-3.5 mg/dl

CALCIUM9.7 mg/dl10.2- 8.6 mg/dl

PHOSPHOROUS2.2 mg/dl4.5-2.5 mg/dl

SODIUM138 mEq/L145-136 mEq/L

POTASSIUM3.2 mEq/L5.1-3.5 mEq/L

CHLORIDE100 mEq/L98-107 mEq/L

USG:-

IMPRESSION:

MULTIPLE CYSTS IN B/L LIDNEYS ALMOST COMPLETELY REPLACING RENAL PARENCHYMA

B/L POLYCYSTIC KIDNEY

2D ECHO:

RWMA + ANT WAL HYPOKINESIA

EF 52%

FAIR LV FUNCTION

DIASTOLIC DYSFUNCTION+

MINIMAL PE+

DILATED LA

MILD DIALATED LV


Treatment Given:-

FLUID RESTRICTION <1.5L/DAY

SALT RESTRICTION<2G/DAY

TAB NODOSIS 1000MG PO TID

TAB SHELCAL CT PO OD

TAB OROFER XT PO OD

TAB NICARDIA 20MG PO TID

INJ IRON SUCROSE 100MG IV BD

INJ EPO 1000 IV SC STAT

SYP GRILLINTUS 15ML PO TID

NASIRION NASAL DROPS

TAB ATXIM 200MG PO BD

TAB MONTEX PO BD

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