A 57 year old male came with bilateral leg swellings and decreased urine output

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A 57 year old male resident of gopalpally farmer by occupation came to OPD with

cheif complaints of

- bilateral leg swellings since 7 days 

-decreased urine output since 2 days

 -excess sweating since 4 hours . 

HISTORY OF PRESENTING ILLNESS-

-Patient was apparently asymptomatic 15 years back then developed polyuria and polyphagia and diagnosed with diabetes mellitus and he is on oral hypoglycemic drugs . 

- 5 years back he developed right arm and leg paralysis then he was diagnosed with hypertension and now he is on metXL- 25.

- Since 7 days he had bilateral pedel edema upto knees , facial edema 

- since 6 days he is having hand swelling 

- since 2 days his urine output is decreased and associated with burning micturition

- there is a history of shortness of breath since 1 day ( 1-2) which is not associated with cough , aggrevated on walking , relieved on rest.

PAST HISTORY - 

He is known case of Diabetes since 15 years ,

(GluconormPG1 metformin + glimiperide + pioglitazone ),  hypertension since 5 years(metXL 25mg) 

Not a known case of TB, epilepsy, asthma 

No history of previous surgeries 

PERSONAL HISTORY -

-He wakes up at 4:30 am then he goes to his farm do agriculture work 

-Then after 1 hour he comes to home and have tea and then goes again for the work 

- then comes in the afternoon and have lunch ( rice and dal ) 

- for dinner also he will have rice 

-Appetite is decreased

- sleep is adequate

- bladder - decreased urine output since 2 days 

- bowel movements - regular 

- Addictions - consumes alcohol 

  since 40years -Full bottle daily 

  Since 2 months  - quarter

  H/O smoking 25 years ago

 Presently he quitted smoking

GENERAL EXAMINATION - 

patient is conscious, coherent and cooperative and we'll oriented with time , place and person .

He is well built and nourished 

No signs of pallor , icterus , cyanosis , clubbing , generalised lymphadenopathy .

He is having bilateral pedal edema , pitting type since 7 days .

VITALS :

Temperature : 94.6°F

PR:102bpm 

RR:16cpm

BP:190/120mmhg 

SpO2 :96%

GRBS : 55mg%

Systemic examination:

CVS: 

S1,S2 heard , no murmers

RS:

Dyspnea - grade 1 present 

Trachea is central 

Bilateral air entry present

NVBS heard

ABDOMEN:

INSPECTION :

Shape of abdomen- Obese.

Scar present. 

No engorged veins.

Hyperpigmented spots on Right Side of abdomen

PALPATION :

No local rise of temperature .

No tenderness .

No palpable mass.

Liver and Spleen - Not palpable .

PERCUSSION:

Normal liver span.

Tympanic note heard over stomach region .

ASCULTATION:

Bowel sounds heard.

INVESTIGATIONS :

8-10-22

9-10-22

PROVISIONAL DIAGNOSIS :

Acute kidney injury secondary to

  ? Diabetic nephropathy 

  ? Nephrolithiasis 

Recurrent hypoglycemia secondary to ? OHA induced 

TREATMENT:

1.Inj.25%D infusion@50ml /hr

2.IVF NS @urineoutput +30ml/hr

3.inj.LASIX 40mgIV BD

4.tab.NICARDIA 20mg BD

5.tab.ARKAMIN 0.1mg TD

6.tab.NODOSIS 500mg BD

7.tab.SHELCAL 500mg OD

8.tab.bioD3 weekly

9.tab.MET XL 25mg OD

10.inj.MEROPENUM 500mg IV/BD

11.inj.BICARB 50meq IV/BD