A 28year old patient came to opd with cheif complaints of seizures of three episodes

 28year old male with ureamic encephalopathy with CKD on maintenance hemodialysis

January 12, 2022.

28 year old male pt , resident of nalgonda district who is a sales man in cloth store, presented to casualty ( on 22/12/21)     with  the chief complaints of

 A. Seizures 

H/o seizures 3 episodes around 3am, 7am, 11am. Each episode lasting for 3-5 min associated with uprolling of eyeballs, frothing from mouth.

Not associated toungue bite, involuntary micturition, involuntary defecation, lethal cry.

Followed by post ictal confusion lasting for 15-20 mins 

B . H/o fever 1 week back associated with chills .

C .  H/o sob since 10 days, grade II - III.

D . H/0 chest pain since 3 days  

D . Negative history  

No H/o hematuria , frothy urine, nausea,  loose stools, decreased urine output, pedal edema.

( but there is history of vomiting during dialysis on 23rd)

History of present illness: 

Pt was apparently asymptomatic 10  (February 2021)months back then

1)  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 and his creatinine levels are high  

2) for which he was advised to undergo dialysis I /v/o high creatinine levels.

3) he went to other hospital in Hyderabad  and  they tested and told him he was HYPERTENSIVE  along with decreased kidney size  and suggested dialysis  

4 ) he came to our hospital  for dialysis , here he tested COVID + in APRIL 2021 , then he came back for dialysis after 2 months on JUNE 24TH 

5 ) K/c/o CKD since April 2021 and is on MHD since June underwent 27 sessions of hemodialysis., Discontinued from 19/10/21 ( SEPTEMBER) 

6) then he presented with fever,  seizures on DECEMBER,  where the dialysis was done 5 sessions till  10 / 1 / 22    

      He had a altered behaviour....and confusing about place and trying to take the cannula  on the 3 to 4 days of admitting  ( 22/ 12 / 21 ) 


Past history  : 

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.

 A ) Pallor +,                                                                         B) no signs of icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.

 C ) 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+

           Pleural rub   is present  

     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

Provisional diagnosis :  UREMIC ENCEPHALOPATHY WITH CKD ON MHD 

CKD ON MHD WITH DIALYSIS DYSEQUILIBRIUM SYNDROME, WITH HYPERTENSIVE NEPHROPATHY WITH K/C/O HTN.

Clinical pictures: 







INVESTIGATIONS
  
22/12/2021















 

24/12/2021


25/12/2021




27/12/2021








Treatment: 

1) Fluid restriction( 1 ltr per day)
2)salt restriction( 2.4 g per day)
3)Tab NODOSIS( 550mg )PO/OD
4)Tab SHELCAL(500 mg) PO/OD
5)Tab OROFER Po/ OD
6)Tab LASIX 40 mg PO / BD
7)TAB NICARDIA 10 mg PO/BD

12/01/2022

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