64 yr old male with altered sensorium,?uremic encephalopathy


A 64yr old male presented to casualty with 3 day history of slurring of speech with 
Worsening breathlessness since 2 days 
Decreased urine output since 2 days 
B/l Pedal oedema since 10 years on and off 

He used to work as farmer and occasionally as shepherd and most of the time stays at home ( eat ,sleep,repeat ) and occasionally indulging in alcohol ( festival times) and he used to have weakness in both lower limbs and sometime unable to stand too and shows recurrent pattern twice or thrice a year and subsided on taking medication.

History of pedal oedema dates back to 10 years prior to the presentation on and off and usually self resolves or OTC medication not associated with shortness of breath, hematuria or decreased urine output, palpitations.

3 days prior to the presentation response to commands decreased and loss of appetite was apparent and decreased urine output with shortness of breath amounting to grade 4, with cough with scanty sputum ( most of the time grunts) and slurring of speech, there was no apparent weakness of extremities. He was taken to Govt hospital yesterday morning and was brought to our hospital.

General examination :

Pt is conscious,coherent and cooperative.Moderately built and nourished.

No pallor
No icterus
No clubbing
No lymphadenopathy
No edema
 
Vitals :

Temp : Afebrile
BP : 130/80 mm Hg
PR : 86 bpm
RR : 22 cpm
GRBS : 105 mg / dl
SpO2 : 94 % @ RA

Systemic Examination :
CVS : S1S2 + , No murmurs
RS : BAE + , NVBS +
P/A : Soft , Nontender , BS +
CNS : NAD

Provisional diagnosis : 

URAEMIC ENCEPHALOPATHY WITH REFRACTORY METABOLIC ACIDOSIS

Clinical images :

Investigations:
On 7/12/21:
   2D Echo:
ECG:
ABG:
Blood urea:
Serum creatinine:
Serum electrolytes:
PLAN 

1.O2 supplementation if SpO2 < 90%
2.INJ LASIX 40 MG IV TID
3.TAB NODOSIS 550MG PO BD
4.TAB SHELCAL 500 MG PO OD
5.SALT RESTRICTION < 2.4 GM / DAY
6.FLUID RESTRICTION < 1 LITRE / DAY


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