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?
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