genaral medicine case 2

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A 60 old male patient presents to opd with complaints of swelling from below waist and has got pain in upper back and lower back and fatigue.

History of present illness:

Patient was apparently asymptomatic 3 months back and had pedal edema and has gradual onset and slow progressive and shortness of breath on exertion and decreased urine output.

History of past illness:

Patient was admitted to opd with a condition of kidney failure with nausea and vomiting.

Patient had a minor surgery near neck .

Patient is hypertensive and developed diabetes since 4 days during investigations.

Personal history:

Appatite : normal

Diet : mixed

Bowel and bladder movement : regular 

Habits: occasional consumption of alcohol

Family history:

No similar condition resemblance in family.

General examination:

Pallor: yes 

Cyanosis: no 

Icterus:no 

Lymphedenopathy:no

Clubbing of toes or fingers: no 

Oedema of feet: yes 

Vitals 

Temperature: afebrile

B.P.: 170/100 

Pulse rate: 98

Systemic examination

CVS:

S1 S2 can be heard.

Respiratory system.

Dyspneoa:yes 

Wheeze:no 

Position of trachea:central 

Abdomen:

Shape of abdomen: scaphoid 

Palpable mass: none 

Palpable spleen:absent 

Palpable liver:absent 

Bowel sounds: yes 

Provisional diagnosis: 

CKD on MHD 

Investigations:

HBSag rapid test- negative 

Anti-HSV antibodies rapid test-non reactive

Serum iron-100ug/dl(normal range 61-157)

Bleeding time-2min30sec

Clotting time-5min

RBS-258

Blood urea-192

Serum creatinine-15.7

Treatment: 

Inj. lasix40mg-BID 

Tab. Nodosis500mg-BID 

Tab crofer-BID 

Tab shelcal-OID 

Inj erythropoietin 1000U SC-weekly twice

Fluid restriction<1.5l/day 

Salt intake restriction<4g/day

 

What stimulated to cause vomiting in the patient?

Is hypertension the cause for sudden onset of diabeties in the individual?