54 year old Man with seizures and diabetes

 54 year old man, with Hotel Business in Cherlapally since 10 years came to Kamineni hospital with

C/O decreased appetite since 2 months after dialysis at kamineni

C/O dyspnea grade 3 since 2 monthS

C/O generalised weakness since 2 months

C/O decreased appetite 

C/O seizures (GCTS) on 23rd September 2020 in night ( MEDICATION TAKEN)



O/E

No fever spikes. Complaints of drowsiness since yesterday

BP: 90/60 mmhg

PR : 82 bpm

RR: 22  

CVS : S1 S2 heard no murmurs

RS: BAE+ Coarse crepts heard diffusely present


CBP: 

Hb - 8.6 g/Dl


TC - 8800 


RBC - 2.95 ( Normocytic Hypochromic )


PC - 40,000


GRBS- 148 mg/Dl

RFT:

Urea : 101

creat: 4

uric acid : 5.1

Ca :8.2

P : 2.2

Na: 134

K: 4.5

Cl: 99


ABG:

pH : 7.4

pCO2: 20.8

pO2: 121

HCO3 : 14

BEB- 8.3

BEecf : 9.4

SpO2 : 97.7%


PAST HISTORY-


Patient is an alcoholic since 10-15 years. Half bottle daily

Epileptic since 6 years , monthly one episode (Epitoin - still continues) Admitted in Gandhi hospital 3 years back for that

Diabetic since 6 years ( Initially on OHAs now on insulin since 5 years) 5-10-5 units human mixtard

Admission to Kamineni in De-addiction centre 3 years ago

H/O pedal edema ans facial puffiness 2 years ago and loose stools sleep disturbances and vomitings for  6 months 1 year ago for which admitted in Gandhi hospital and started on dialysis. 10 dialysis per month weekly thrice for 1 year

Hypertensive since 2 months

No usage of any other medicines












Provisional Diagnosis : 

Diabetic Nephropathy on Maintenance Hemodialysis with K/C/O Epilepsy and Hypertension




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