1702102033 LONG CASE

A 75 year old came to casualty with c/o fever cold cough since 4 days.


patient was apparently asymptomatic till 2003 , then patient had B/L knee pain which gradually aggravated, then patient was started on NSAID'S daily for 3 years.

Then in 2006- one day pt had continuous episodes of loose stools, 12-14 episodes per day with ? Anuria. 
In view of anuria he went to nephrologist > ? AKI > Advised dialysis > patient underwent 1 session of hemodialysis.

2 YEARS BACK : pt experienced Polyuria , polydypsia for 2 days for which he visited nearby RMP and was diagnosed as DIABETIC and started on OHA.

At present since 10 DAYS , patient had decrease of appetite, generalised weakness> took OHA and didn't take any food. Then Patient experienced 1 episode of hypoglycemia GRBS: 18 mg/dl ( frothing and uprolling of eyes). Then his attender gave him sugar water and 25 D Infusion in ambulance- Recovered.
Had similar episode 2 days back.
decrease in Appetite since 10 days.

C/o fever since 4days high grade, intermittent,not associated with chills and rigors,relieved on taking medication.
C/o cough since 4days, productive type,whitish in colour,moderate amount,non blood stained,non mucoid. 

k/c/o Diabetes since 10 years

Addictions: Chronic smoker ( chutta) 5-6/day for 30 years


O/E
Temp: 96.9 F
PR: 68 bpm.
BP: 120/90 mm hg.
Spo2 : 98% @ RA.







Systemic examination:

CVS: S1 S 2 heard
RS: wheeze+ coarse crepts+ bilaterally.
P/A : soft, non tender.
CNS: NAD.


PROVISIONAL DIAGNOSIS: Pyrexia under Evaluation with DM type 2. ? Chronic bronchitis.
? CKD

Investigation:















DIAGNOSIS:

Chronic bronchitis with Type-2 DM
?CKD


TREATMENT:

- IVF NS @ 20 ml/kg/hr IV stat.
  Ns @ 10ml/kg/hr continuous.
-Inj. PANT OP 40MG IV/OD.
-INJ.ZOFER 4 mg IV/SOS
- INJ.NEOMOL 1gm IV/SOS ( temp > 101 F)
- Inj. HAI S/C according to sliding scale.
- Nebulisation with BUDECORT 12th hrly.
- Grbs 6 th hrly.
- vitals monitoring 4 th hrly.

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