PATIENT CAME WITH C/O PEDAL EDEMA,TINGLING SENSATION OF LOWER LIMBS & POLYDYPSIA

 Case History and Clinical Findings:-

PATIENT CAME WITH

C/O PEDAL EDEMA SINCE 1 WEEK

C/O TINGLING SENSATION OF LOWER LIMBS SINCE 1 WEEK

C/O POLYDYPSIA SINCE 1 WEEK

HOPI:

PT WAS APPARENTLY ASYMPTOMATIC 1 WEEK BACK THEN HE HAD TINGLING SENSATION OF BOTH LOWER LIMBS SINCE 1 WEEK. POLYDYPSIA, POLYURIA, NOCTURIA

NO ABDOMINAL PAIN, VOMITINGS, LOOSE STOOLS

NO H/O CHEST PAIN, PALPITATIONS, SOB, FEVER, COLD, COUGH

PAST HISTORY:
PAST 2 YEARS BACK HE HAD ALTERED SENSORIUM AND DIAGNOSED TO HAE ?DKA, GIVEN INSULIN AND TREATED. AFTER 10 DAYS PATIENT DEVELOPED SWELLING OF LOWER LIMBS AND ULCERATION ON RIGHT TOE AND PLANTAR ASPECT OF FOOT FOR WHICH HE WAS TREATED 4 MONTHS BACK HE HAD ALTERED SENSORIUM SECONDARY TO HYPONATREMIA ?SIADH WITH HYPOKALEMIA. 2 MONTHS BACK HE AGAIN GOT ADMITTED WITH PEDAL EDEMA, ANASARCA, DECREASED URINE OUTPUT, VOMITING, LOOSE STOOLS
K/C/O DM 2 SINCE 10 YEARS
K/C/O HTN SINCE 4 YEARS
NOT K/C/O TB, ASTHMA, CAD, CVD

PERSONAL HISTORY ;
DIET : MIXED
APPETITE : NORMAL
SLEEP : NORMAL
BOWEL AND BLADDER : MICTURITION INCREASED SINCE 1 WEEK, BOWEL MOVEMENTS REGULAR
NO ADDICTIONS
NO ALLERGIES

FAMILY HISTORY :
NO SIGNIFICANT FAMILY HISTORY

GENERAL EXAMINATION :
PATIENT IS CONSCIOUS , COHERENT , COOPERATIVE
MODERATELY BUILT AND NOURISHED .
NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING ,LYMPHADENOPATHY, EDEMA.

VITALS :
TEMPERATURE: 98.4F
PR - 96BPM
BP - 140/90 MMHG
RR - 24 CPM
SPO2 - 96% ON ROOM AIR
GRBS -732 MG/DL

SYSTEMIC EXAMINATION :

PER ABDOMEN :

INSPECTION :

ABDOMEN IS SCAPHOID
UMBILICUS IS CENTRAL
ALL QUADRANTS ARE MOVING EQUALLY WITH RESPIRATION
NO SINUSES , ENGORGED VEINS, VISIBLE PULSATIONS .
HERNIAL ORIFICES ARE FREE.

PALPATION :
NO LOCAL RISE OF TEMPERATURE
NO TENDERNESS
LIVER AND SPLEEN - NOT PALPABLE
PERCUSSION : TYMPANIC NOTE HEARD OVER THE ABDOMEN.
FLUID THRILL ABSENT
SHIFTING DULLNESS ABSENT

AUSCULTATION :
BOWEL SOUNDS ARE HEARD.
CARDIOVASCULAR SYSTEM :

INSPECTION:
SHAPE OF CHEST IS ELLIPTICAL.
NO RAISED JVP
NO VISIBLE PULSATIONS, SCARS , SINUSES , ENGORGED VEINS.

PALPATION :
APEX BEAT - FELT AT LEFT 5TH INTERCOSTAL SPACE
NO THRILLS AND PARASTERNAL HEAVES

AUSCULTATION :
S1 AND S2 HEARD.

RESPIRATORY SYSTEM:
INSPECTION:
SHAPE- ELLIPTICAL
B/L SYMMETRICAL
BOTH SIDES MOVING EQUALLY WITH RESPIRATION .
NO SCARS, SINUSES, ENGORGED VEINS, PULSATIONS

PALPATION:
TRACHEA - CENTRAL
EXPANSION OF CHEST IS SYMMETRICAL.
VOCAL FREMITUS - NORMAL

PERCUSSION: RESONANT BILATERALLY

AUSCULTATION:
BILATERAL AIR ENTRY PRESENT
NORMAL VESICULAR BREATH SOUNDS HEARD
CENTRAL NERVOUS SYSTEM:
E4V5M6
SPEECH- NORMAL
NO SIGNS OF MENINGEAL IRRITATION.
CRANIAL NERVES- INTACT
SENSORY SYSTEM- NORMAL

MOTOR SYSTEM:
TONE- NORMAL
POWER- BILATERALLY 5/5
REFLEXES RIGHTLEFT
BICEPS ++ ++
TRICEPS. ++. ++
SUPINATOR + +
KNEE. ++ . ++
ANKLE + +
BILATERAL PLANTAR FLEXOR

COURSE IN HOSPITAL:
A 60 YEAR OLD MALE PRESENTED WITH ABOVE MENTIONED COMPLAINTS AND ON FURTHER EVALUATION PATIENT WAS FOUND TO HAVE UNCONTROLLED SUGARS AND STARTED ON INSULIN INFUSION INITIALLY AND LATER BRIDGED TO HAI AND NPH AND SODIUM CORRECTION WAS DONE WITH 0.9%NS AND POTASSIUMJ CORRECTION WAS DONE WITH KCL INJECTION. SUGARS WERE CONTROLLED AND HYPONATREMIA AND HYPOKALEMIA ARE CORRECTED.
PATIENT RECOVERED SYMPTOMATICALLY AND DISCHARGED IN STABLE CONDITION .

Diagnosis
UNCONTROLLED SUGARS SECONDARY TO NON COMPLAINCE WIH PSEUDO HYPNATREMIA(RESOLVED)
K/C/O ? ADULT ONSET BARTERS
PRERENAL AKI(RESOLVED) RESOLVED ON CKD
WITH TYPE 2 DM SINCE 18 YEARS, HTN SINCE 4 YEARS

Investigation
HEMOGRAM:29/4/23
HB: 10.9
TLC: 10,400 CELLS/CUMM
N/L/E/M: 80/15/1/4
PLT COUNT: 2.26
ECG: NORMAL SINUS RHYTHM
HBA1C-8.1
FBS(1/5/23)
129 MG/DL
HEMOGRAM:1/5/23
HB: 10.4 GM/DL
TLC: 9,900 CELLS/CUMM
N/L/E/M: 69/22/4/5
PLT COUNT: 2.32

Treatment Given(Enter only Generic Name)
1. INJ HAI S/C TID
INJ NPH S/C BD
2. 1 AMP KCL IN 500 ML NS OVER 6 HOURS
3. IVF NS @100 ML/HR
4.TAB CINOD 10 MG PO/BD
5. TAB MET XL 25 MG PO/OD
6. SYP POTKLOR 10 ML IN GLASS OF WATER PO/TID

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