A 55 year old male on dialysis

 A 55 year old male on dialysis 


A 65 year old male who used to work as a farmer until 5 years ago came from x to the medicine department for his scheduled dialysis. 


History of present illness 

The patient was apparently asympatamatic 7 months ago he was brought to the hospital when  he became unconscious and fell due to hyperglycemia, his FBS was later found to be 400 gm/dl.


He was in a coma for 8 days. He developed rashes all over his body 6 months ago which initially started on the legs and gradually spread to the whole body. He developed grade 4 shortness of breath 4 months ago. 

2 months ago he developed generalized weakness and body pain which was prickling only type and fluctuating  in nature , there were no aggravating or relieving factors. In the last 2 months he had 2 episodes of non projectile vomitings of the gastric contents. 


H/o burning micturation, with decreased frequency and urinary retention which was dark yellow in color. 


H/o constipation.


Past history 

The patient is a known case of diabetes nell’ictus since the last 20 years and raffles insulin regularly. 

He is a known case of hypertension since the last 5 years and consumes amlodipine  off.

He is not a known case of asthma, TB, epilepsy, thyroid disorders or CVS disorders.


Family history

His mother and father are a known case of SM and HTN


Surgical history

No previous surgeries


Personal history

Mixed diet

Los of appetite

Inadequate sleep

Dark yellow colored urine with burning micturation, decreased frequency and urinary retention 

Consultation 

Addicting- consumes 90 ml alcohol regularly

Smokes needi one pack a day and has a history of 20 pack years 


Daily YouTube

6 am - wakes up

6:30 am - 1 cup tea 

9 am - tiffin (4 idlies)

1 pm - lunch (rice, curry, dal)

5 pm - 1 cup tea

8:30 on - dinner (4 idlies)




General examination

Conscious 

Coherant 

Cooperative 


pallor present 





No icterus 

No clubbing of fingers 



 No lymphadenopathy 

No cyanosis 

No pedal orders 



Vitals 

Temperature- afebrile 

Pulse- 90 nom

BP- 120/80

Respiratory rate- 16 rpm


Systemic examination 


Respiratory system examination 


Inspection


•Chest is bilaterally symmetrical

Trachea – midline in position

Apical Impulse is not appreciated 

Chest is moving normally with respiration.

No dilated veins, scars, sinuses.



Palpation


•Trachea – midline in position.

Apical impulse is felt on the left 5th intercoastal space.

Chest is moving equally on respiration on both sides

Tactile Vocal fremitus - appreciated 



Percussion 


The following areas were percussed on either sides- 


Supraclavicular-resonant

Infraclavicular- resonant

Mammary- resonant

Axillary- resonant

Infraaxillary- resonant

Suprascapular- resonant 

Infrascapular- resonant 

 interscapular - resonant.


Auscultation 

•Normal vesicular breath sounds heard.



Abdominal examination 


No fluid  thrill

No shifting  dullness 




CVS examination 


S1,S2 heard, no murmurs 

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