60M ALTERED SENSORIUM, ACUTE CVA, PARAXIAL AF WITH FVR, AKI ON CKD, RENAL ANAEMIA, HIGH SAAG LOW PROTEIN ASCITES

PRESENTING COMPLAINTS 

PATIENT CAME WITH C/O.SLURRING OF SPERCH SINCE 3 DAYS
ABDOMINAL DISTENSION SINCE 3 DAYS
DECREASED URINE OUTPUT SINCE 2 DAYS

HISTORY OF PRESENTING COMPLAINTS :
PATIENT WAS APPARENTLY NORMAL 8 DAYS AGO, THEN HE DEVELOPED LOOSE STOOLS 3-4 EPISODES PER DAY. PATIENT WENT TO OUT SIDE HOSPITAL AND TREATED THERE. SINCE 3 DAYS PATIENT HAD DEVELOPED SLURRING OF SPEECH AND WHICH IS INSIDIOUS IN ONSET AND GRADUALLY PROGESSIVE. ABDOMINAL DISTENSION SINCE 3DAYS SUDDEN IN ONSET FOLLOWED BY DECREASE IN URINE OUTPUT AND INVOLUNTARY MICTURITION.    

PAST HISTORY:
K/C/O. HYPERTENSION SINCE 3YRS, ON TAB. CILINDIPINE 10MG. OD
NO H/O. DIABETES MELLITUS 
NO H/O. CAD /CVA 
NO H/O. TB/ ASTHMA / EPILEPSY 

TREATMENT HISTORY:
ON TAB. CILINDIPINE 10MG.SINCE 3 YRS

PERSONAL HISTORY: 
Diet - mixed 
Appetite - normal 
Bladder - decrease in urine output 
Bowel - constipation
Sleep - adequate 
Alcohol - Regular 90ml/day stopped 20yrs back
No h/o.Smoking
No drug addictions 

FAMILY HISTORY:
No H/O HTN/DM/TB/ASTHMA/EPILEPSY/CAD/THYROID DISORDERS in the family.

PROVISIONAL DIAGNOSIS 
ALTERED SENSORIUM, ACUTE CVA, PARAXIAL AF WITH FVR, AKI ON CKD, RENAL ANAEMIA, HIGH SAAG LOW PROTEIN ASCITES 

GENERAL PHYSICAL EXAMINATION:
HEIGHT - 165 cms
WEIGHT - 65 kg
NO PALLOR 
NO ICTERUS 
NO CYNOSIS 
NO CLUBBING 
NO LYMPHEDNOPATHY 

DAY 1 ON EXAMINATION: 22/04/2025 at 3.30 PM
TEMP - 98. 3 f
PULSE - 98/min regular
HR - 104/min 
APEX PULSE DEFICIT - 6
BP - 180/90 mm of hg
RR - 20 / min
SPO2 - 98% on RA 
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , NVBS 
PA - SOFT , NON TENDER 
CNS - NFND 
GRBS - 84 mg/dl 

Popular posts from this blog

58 YRS MALE , ATRIAL FLUTTER WITH VARIABLE BLOCK , HEART FAILURE WITH REDUCED EJECTION FRACTION ( 38%) PRE RENAL AKI ON CKD , K/C/O. VALVULAR AF WITH FVR ,SECONDARY TO CHRONIC RHEUMATIC HEART DIDEASE WITH MITRAL STENOSIS, K/C/O.COPD , DENOVO. HYPERTENSION.

58yr Old male patient complaints of FEVER since 10days, COUGH since 10days , SHORTNESS OF BREATH since 10days. HOPI:  Patient was apparently asymptomatic 10days back suddenly he had high grade fever associated with chills and rigors , relieved by medication  COUGH since 10 days non-productive associated with difficulty in breathing which is grdae-lll mmrc  and Decrease in urine output , , pedal edema on and off below knee pitting type more towards evening and less in early morning . No H/o.chest pain , No H/o. Palpitations , No H/o. Pnd / orthopnoea  PAST HISTORY:  Known case of HYPERTENSION since 5yrsk Known case of CRHD with AF ,FVR NO H/o.DM,TB, ASTHAMA, EPILEPSY, THYROID DISORDERS  TREATMENT HISTORY: He is on Tab.ISOSARBIDE DINITRATE 20mg BD since 3 months Tab.APAXIBAN 5mg since 3 months  Tab.ROSVAS 10mg since 3 months  Tab.Diltiazem 90mg since 5 days  Tab.Lasix since 5 days  Tab. Eplirenone 25mg since 5days Tab. APAXIBAN 5mg since 3...
Read more

84 MALE , COMMUNITY ACQUIRED PNEUMONIA , TYPE- ll RESPIRATORY FAILURE, PARAXYSMAL AF WITH FVR , HFMEF (EF-45,%) , K/C/O.BRONCHIAL ASTHAMA

Image
PRESENTING COMPLAINTS: 84 YEARS MALE PATIENT C/O.SHORTNESS OF BREATH SINCE MORNING  FEVER SINCE 5 DAYS.  HISTORY OF PRESENTING COMPLAINTS : The patient was apparently asymptomatic before  3yrs gradually he had shortness of breath on and off, which is of GRADE -ll NYHA and sinc morning he had sudden onset of severe shortness of breath associated with minimal exertion.  fever since  5 days associated with chills and rigor intermittent and High grade .   Cough with sputum since 5days whitish in colour, copious in amount. PAST HISTORY: NO H/O. HYPERTENSION  NO H/O. DIABETES MELLITUS  NO H/O. CAD /CVA  NO H/O. TB/ ASTHMA / EPILEPSY  TREATMENT HISTORY: NO PREVIOUS HISTORY OF MEDICATIONS  PERSONAL HISTORY:  Diet - mixed  Appetite - normal  Bladder and Bowel - Regular  Sleep - adequate  Alcohol - Regular 90ml/day since 20yrs Smokes 1pack/day since 20yrs  No drug addictions  FAM...
Read more

DR VENKANNA'S THESIS

TITLE CLINICAL PROFILE, COMORBIDITIES AND OUTCOMES IN PATIENT WITH CARDIAC ARRHYTHMIAS PROBLEM STATEMENT : Arrhythmias are a common dilemma confront- ing the intensivist. They represent a major source of morbidity, and they lengthen hospital stay. Arrhythmias are most likely to occur in patients with structural heart disease. The inciting factor for an arrhythmia in a given patient may be an insult such as hypoxia, infection, cardiac ischemia, catecholamine excess (endogenous or exogenous), or an electrolyte abnormality. Management includes correction of these imbalances as well as medical therapy directed at the arrhythmia itself. The physiological impact of arrhythmias depends on ventricular response rate and duration as well as on the underlying cardiac function. Bradyarrhythmias may decrease cardiac output due to heart rate alone in patients with relatively fixed stroke volumes, and loss of an atrial kick may cause a dramatic increase in pulmonary pressures in patients with diastol...
Read more