28/M with UREMIC ENCEPHALOPATHY with CRF
A 28 year old male who is a sales man in cloth store, presented to casualty ( on 22/12/21).with h/o seizures since last night.
H/o seizures 3 episodes around 3am, 7am, 11am. Each episode lasting for 3-5 min a/w uprolling of eyeballs, frothing from mouth.
Not a/w toungue bite, involuntary micturition, involuntary defecation, lethal cry.
Followed by post ictal confusion lasting for 15-20 mins
H/o sob since 10 days, grade II - III.
H/o fever 1 week back a/w chills .
No H/o hematuria .
No h/o frothy urine.
No h/o nausea, vomiting, loose stools.
No h/o decreased urine output, pedal edema.
Pt was apparently asymptomatic 10 (February 2021)months back then he noticed sudden loss of weight of about 10-15kgs, in a span of 1 & 1/2 months for which he consulted local doctor where he was diagnosed to have CKD for which he was advised to undergo dialysis I /v/o high creatinine levels. He came to our hospital for dialysis , here he tested COVID + , then he came back for dialysis after 2 months .
K/c/o CKD since April 2021 and is on MHD since June underwent 24 sessions of hemodialysis., Discontinued from 19/10/21.
K/c/o HTN +.since 8 months.
Not a k/c/o DM, CAD, ASTHMA, TB.
Personal history:
Diet: mixed .
Appetite: reduced
B&b: regular.
Sleep: adequate.
No significant family history.
On examination:
Pt is c/c/c moderately built with mild dehydration.
Pallor +, no signs of icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.
Temp: 98.6 f
PR: 88 bpm
RR: 14 cpm
BP: 160/100 mm hg
SpO2: 98% @ RA
GRBS : 130 mg%
CVS: S1, S2+ no murmurs
RS: BAE+, NVBS+
P/A: SOFT, NON TENDER.
CNS: PT IS CONSCIOUS
SPEECH: NORMAL
NO SIGNS OF MENINGEAL IRRITATION.
REFLEXES: R. L.
B. 2+. 3+
T. 3+. 3+.
S. -. 3+.
K. 3+. 3+
A. -. -.
P. REDUCED
POWER: R. L.
UL. 5/5. 5/5
LL. 5/5. 5/5
TONE:. R. L.
UL. N. N.
LL. N. N.
Gait: normal
PD: ? UREMIC ENCEPHALOPATHY WITH CKD ON MHD
CRF WITH DIALYSIS DYSEQUILIBRIUM SYNDROME, WITH HYPERTENSIVE NEPHROPATHY WITH K/C/O HTN.
On 22/12/21:
On 24/12/21:
On 25/12/21:
On 27/12/21:
Dialysis done on 23/12/21 & 26/12/21
Day 7 :
CKD WARD:
S:
NO FEVER SPIKES
O:
PT IS CONSCIOUS, NON COHERENT AND COOPERATIVE,
AFEBRILE
BP:140/90 MM HG
PR: 90 BPM
CVS: S1S2 + NO MURMURS
RS: BAE+
P/A: SOFT, NON TENDER.
GRBS: 105 MG/DL
A:
CRF WITH ( DIALYSIS DYSEQUILIBRIUM SYNDROME), WITH HYPERTENSIVE NEPHROPATHY WITH K/C/O HTN.
P:
SALT RESTRICTION LESS THAN 2.4GMS/DAY
FLUID RESTRICTION LESS THAN 1 LIT/DAY
TAB. NODOSIS 550MG PO/ BD
TAB. SHELCAL 500 MG /PO /OD
TAB. OROFER PO/OD
TAB. LASIX 40 MG PO/BD
TAB. NICARDIA 10 MG /PO/ BD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491204/
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