45 year male with Parotid swelling.

​  This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs.

A 45-y male patient, a farmer by occupation came with c/o  painless swelling on the right side of his face since 5 months.

The patient was apparently alright 18 months back, then he noticed a Swelling on the right side of his face, initially small in size later increased in size for which the patient had sought consultation and underwent superficial parotidectomy on 13/11/2022 and was diagnosed to be having Right Pleomorphic Adenoma, then pt c/o gradual increase in the size of the right parotid gland 

And c/o painful oral ulcer at right retromolar trigone area since 4 months.

Not a known case of  DM, HTN, BA, EPILEPSY, TB, CAD or CVA.

Personal history-

Appetite -normal

Diet-mixed

B&B -regular

Addictions- pan daily twice, since 7 years.

Image showing Right Parotid Swelling, at the time of presentation to our OP.

Oral hygiene and Ulcer at Right RMT.

ECG at the time of presentation:

Chest X-ray PA view:

Outside Investigations-

Plain + CE MRI OF NECK:

TRU-CUT Biopsy from Right Parotid Region

Incisional Biopsy from Right Parotid Gland

General examination -

Pt is conscious, coherent and cooperative 

Bp-120/80mmhg

PR-78 bpm

RR-18 cpm

Grbs-148 mg/dl

No pallor, icterus, cyanosis, clubbing, lymphadenopathy 

Systemic Examination-

CVS-S1, S2+, No murmurs 

RS-BAE+, NVBS, No added sounds

P/A-soft, non-tender

CNS-

HMF+

GCS-15/15

POWER

        RT        LT

UL- 5/5       5/5

LL- 5/5        5/5

Reflexes-

        Rt               Lt

B       ++               ++

T       ++                ++

S        ++               ++

K         ++                ++

A         ++                 ++

P    dorsiflexion

Diagnosis-RIGHT PLEOMORPHIC ADENOMA WITH RIGHT RMT ULCER

75yr male Type-2Respiratory failure with respiratory acidosis with acute CVA Lf hemiparesis(3days),Intubated I/v/o poor GCS(E1V1M4) & Hypercapnia connected to ventilator in ACMV-Vc mode

​This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient' problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome."

I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan. 

  

Case:A 70 year old male construction labourer by occupation was bought to casualty in unconscious state.

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 20days back and later developed sob and cough not associated with sputum for which patient got treated in local hospital and the symptoms subsided on medication. Patient complained of  inability to move left arm and left leg 4days back and had fever 6hours back for which he was given p650. Patient became unconscious at 4pm and was brought here for further management and treatment.

patient is a known case of Asthma since 4 years and diagnosed denovo hypertension and is on telmisartan 40mg.

not a known case of diabetes epilepsy.

HISTORY OF PAST ILLNESS:

                       There is no history of EPILEPSY.

Treatment history:

patient is a known case of Asthma since 4 years and is on medication

K/c/o  denovo hypertension and is on telmisartan 40mg.

 ON EXAMINATION

VITALS  on admission

TEMPERATURE - Afebrile

PULSE RATE - 92 bpm

BLOOD PRESSURE - 

70/50 mmHg

RESPIRATORY RATE - 20 cpm

SPO2 - 66% @ RA

GRBS 238MG/DL

SYSTEMIC EXAMINATION - 

PER ABDOMEN : NON DISTENDED, SOFT NON-TENDER, NO GAURDING/RIGIDITY

CARDIOVASCULAR SYSTEM : 

S1 AND S2 HEARD , NO MURMURS

RESPIRATORY SYSTEM : BAE +

CENTRAL NERVOUS SYSTEM :

 GCS-E0V1M0

INTUBATION DONE on 23/5/2022

As the patient is found unconscious and vitals were unstable

Pre intubation vitals

TEMPERATURE - Afebrile

PULSE RATE - 42 bpm

BLOOD PRESSURE - 

70/50 mmHg

RESPIRATORY RATE - 20 cpm

P/a distended

SPO2 - 66% @ RA

GRBS 238MG/DL

Abg was sent and shown 

pH 7.137

Pco2 68.2

Po2 111

Hco3 17.6

S02 95

As it is showing severe respiratory failure type2 with severe respiratory acidosis and hypercapnea patient was immediately intubated with 8.5mm ET TUBE And connected to ventilator with ACMV -VC mode

PEEP-5CM H2O

VT-450

RR-18

FIO2 100%

POST INTUBATION VITALS

PULSE RATE - 84bpm

BLOOD PRESSURE - 

130/90 mmHg

RESPIRATORY RATE - 20 cpm

P/a distended

SPO2 - 96% @ RA

Post intubation Abg

pH 7.177

Pco2 55.7

Po2 176

Hco3 17

S02 99%with100fio2

 

INVESTIGATIONS

ECG 9:45pm

ECG12:10am

Abg pre intubation

Abg post intubation

2d echo report

Abg on 25/5/22

Provisional diagnosis:

 Type-2Respiratory failure with respiratory acidosis with acute CVA Lf hemiparesis(3days),AKI?,Intubated I/v/o poor GCS(E1V1M4) & Hypercapnia connected to ventilator in ACMV-Vc mode

Treatment

1.RT FEEDS 100ML MILK+100ML WATER 2ND HOURLY

2.IVF NS @50ML/HR

3.INJ CEFTRIAXONE 1GM IV BD

4.INJ NORAD( 2AMP+46ML NS)@14ML/HR

5.INJ DOBUTAMINE (1AMP+45ML NS)@2ML /HR

6.STRICT I/0CHARTING

23 year old male with left single kidney with generalised weakness

​This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box.

A 23year old male patient farmer by occupation came to casualty with c/o : generalised weakness since 1week.

HOPI : Patient was apparently asymptomatic 1week back, then he gradually developed generalised weakness.

PAST HISTORY : Patient is not a  k/c/o HTN,

 h/o DM, tb, epilepsy, cad, asthma.

-H/O Solitary left kidney only since birth.

Patient underwent 3 dialysis in the past.

PERSONAL HISTORY : Diet - mixed, Sleep - adequate, Appetite - normal, Bowel and bladder movements - normal.

GENERAL EXAMINATION : 

Patient is conscious, coherent, cooperative

well oriented to time and place.

No pallor, icterus, cyanosis, lymphadenopathy.

VITALS:

Temp- 98.6F

PR - 92bpm

Spo2 - 99%

RR - 16cpm

GRBS - 110mg/dl

Blood Pressure - 110/80mmhg

CVS - S1,S2+ no murmurs

RS - BAE+, nvbs heard

         no wheeze, no crepts

P/A - Soft, non tender, organomegaly

Bowel sounds +

CNS - NFND

INVESTIGATIONS

PROVISIONAL DIAGNOSIS :

Chronic renal failure with left single kidney.

TREATMENT :

1) FLUID AND SALT RESTRICTIOB

2)TAB NICARDIA 20MG PO/BD

3)TAB NODOSIS 500 PO/BD

4)TAB OROFER- XT PO/BD

5)CAP BIO- D3 PO/BD

6)INJ ERYTHROPOIETIN 5000 IU/SC/WEEKLY ONCE

7)TAB SHELCAL 500MG PO/BD.

Post renal AkI on CKD secondary to BPH

73 yr  male
Pt came with complaints of
1 burning micturition  :: 15 days
2 fever  :: 15 days
3  urge  incotinence :-5days

Pt complaints of  burning  micturation after urination not associated  with loin pain.

Fever high grade intermittent  relieved with medication ,  :: 15 days associated with chills and rigors .

Urinary urgency :: 15 days :: not able to hold urine & wetting of clothes ,foleys catherization was done 
H OPI
pt was apparently  alright  8 year back had h/o poor stream of urine burning micturation ,fever,

 underwent TURP (6 years in nims  back )
Was symptom free for 2 yrs  , again he  developed  similar complaints ,underwent TURP 4 yr back in kims Nkp.

Past illness:
Kco ,HTN  ::10 yrs.
       On  Medications  AMLODIPINE  5 mg  , ATENOLOL 50mg .

DM2 10  yrs  inj . HM 15 IU -x-x -8am.
H/O  TURP.  4 YRS BACK -NIMS,symptom free upto 1 yr ,TURP -2 yr back.

PERSONAL H/O
Appetite normal ,
Mixed diet,
Bowel and bladder movements are  regular
Micturation : Urinary urgency c:: 15 fays :: not able to hold urine & wetting of clothes ,foleys catherization was done for it.
No known allergies
No Addictions.
Family History
No kco dm, htn, cvd ,tb.

On Physical  examination :
Pt was concious, coherent, cooperative
Moderately built,moderately nourished
No signs of pallor ,icterus ,cyanosis, lymphadenopathy, clubbing of fingers/toes.
Temp 98.6F
Pr 62 bp.
RR 22CPM
BP 120/50mm hg
sPO2 96%on RA
GRBS 197 mg%

Y

Provisional Diagnosis:

Post renal Acute kidney injury on chronic kidney disease

Secondary to benign prostate hyperplasia with bilateral Moderate  hydronephrosis 

TRANS URETHERAL PROSTATE RESECTION 4 years----nims

2yrs back ---kims.

 With urosepsis 4 yrs back 
DM2 & HTN.(10yrs)

PROSTATE ADENOCARCINOMA,

B/L ORCHIDECTOMY

CLD

TREATMENT:
1)FOLEYS  catheterization
2) IUF  0.9 %Nacl ( 0.0+30ml/hr)
3)inj. LASIX 40 mg /wBd
4) inj . PIPTAZ 4.5  gm/IU /Stat.
5) inj. PANTOP 40 mg /PO/OD .
6)GRBS  6th  hrly pre meal.
7) INJ. HAI S/C TID agter informing PG  .
8)  hold OHA and Anti hypertensiveS
9) AMLONG  5 mg PO/ OD.

I n v e s t i g a t i o n s :

Previous Reports :

Investigations done after hospitalization 

ECG:

Past usg screening: 

CXray

 Uribe bag after catherization  on 2/7/21.

 

Reports dated 4-7-21

DAY - 3

culture report from day 1 sample.

Reports of investigations done:

DISCHARGE SUMMARY 

Treating doctors

Dr.Rakesh biswas HOD

Dr. Arjun  asst.prof

Dr. Nikitha PGY2

Dr. Pradeep PGY1

Dr. Ranjith Intern

Dr. Tejaswini Intern

Dr.Shravani Intern

Dr. Krupa Intern

Dr. Nikitha Intern

DIAGNOSIS: 

Post renal Acute kidney injury on chronic kidney disease

Secondary to benign prostate hyperplasia with bilateral Moderate  hydronephrosis 

TRANS URETHERAL PROSTATE RESECTION 4 yrs ago nims AND 2 YRS ago kims 

Case history

73 yr  male
Pt came with complaints of
1 burning micturition  :: 15 days
2 fever  :: 15 days
3  urge  incontinence ::5 days.
Pt complaints of  burning  micturation after urination not associated  with loin pain.
Fever high grade intermittent  relieved with medication ,  :: 15 days associated with chills and rigors .
Urinary urgency :: 15 days :: not able to hold urine & wetting of clothes ,foleys catherization was done .
H OPI
pt was apparently  alright  8 year back had h/o poor stream of urine burning micturation ,fever,

 underwent TURP (6 years in nims  back )
Was symptom free for 2 yrs  , again he  developed  similar complaints ,underwent TURP 4 yr back in kims Nkp.

Pt c/o abdominal distension & pain,stools not passed on day1.

--Pt abdominal distension & pain decreased,stools  passed,Pt attendant complaining of irritable behaviour & Sleeplessness at night on day 2. 

--stools passed twice .abdomen distension and pain abdomen relieved on day 3.

---burning sensation  in the mouth since 5 days.

Past illness:

Kco ,HTN  ::10 yrs.
       On  Medications  AMLODIPINE  5 mg  , ATENOLOL 50mg .
DM2  inj . HM 15 IU 00-8am.
H/O  TURP.  4 YRS BACK -NIMS,symptom free upto 1 yr ,TURP -2 yr back.
PERSONAL H/O
Appetite normal ,
Mixed diet,
Bowel and bladder movements are  regular
Micturation : Urinary urgency c:: 15 fays :: not able to hold urine & wetting of clothes ,foleys catherization was done for it.
No known allergies
No Addictions.
Family History
No kco dm, htn, cvd ,tb.
On Physical  examination :
Pt was concious, coherent, cooperative
Moderately built,moderately nourished
No signs of pallor ,icterus ,cyanosis, lymphadenopathy, clubbing of fingers/toes.
Temp 98.6F
Pr 62 bp.
RR 22CPM
BP 120/50mm hg
sPO2 96%on RA
GRBS 197 mg%

Course in the hospital

Day 0(2/7/2021)

Rx

1)Change FOLEYS  catheterization

2) IVF  0.9 %Nacl ( U.0+30ml/hr)

3)inj. LASIX IV 40 mg /Bd

4) inj . PIPTAZ 4.5  gm/IV /Stat.

5) inj. PANTOP 40 mg /IV/OD .

6)GRBS  6th  hrly .

7) INJ. HAI S/C TID after informing PG  .

8)  with hold OHA and Anti hypertensive

S:-Pt c/o abdominal distension & pain,stools not passed

O:-Abdominal Distension Present

Pt is c/c/c

Bp:-120/80mmhg

Pr:-84/min

Cvs:-S1S2 +

Rs:-B/LAE+

CNS:-NFD

P/A:-Soft,Tenderness all over the abdomen,Bowel sounds +

A:-

Post renal AkI on CKD.

Secondary  to BPH With B/L Moderate  hydronephrosis,

s/p TURP 2yrs back ---kims.

4 yrs back Kims 

K/c/o DM2 & HTN.(10years)

P:-

Inv 

USG abdomen 

X-ray erect abdomen

Urology referal i/v/o urinary incontinence

Rx 

1)IVF  0.9 %Nacl ( U.0+30ml/hr)

2)inj. LASIX IV 40 mg /Bd

3)inj . PIPTAZ 2.25 gm/IV /TID

4)inj. PANTOP 40 mg /IV/OD .

5)GRBS  6th  hrly .

6)INJ. HAI S/C TID after informing PG  .

7)Tab Amlodipine 5mg/po/OD

8)Abdominal girth measurement 2nd hrly

9)Proctolysis enema

10)Syp Lactulose 20ml /PO/HS

Day 2(4/7/2021)

S:-Pt abdominal distension & pain decreased,stools  passed,Pt attendant complaining of irritable behaviour & Sleeplessness at night

O:-

Pt is c/c/c

Bp:-110/70mmhg

Pr:-92/min

Cvs:-S1S2 +

Rs:-B/LAE+

CNS:-NFD

P/A:-Soft,Bowel sounds +

Serum Na :-130—->125——>123

A:-

Post renal AkI on CKD.

Secondary  to BPH With B/L Moderate  hydronephrosis,

s/p TURP 2yrs back ---kims.

4 yrs back Kims 

K/c/o DM2 & HTN.(10years) 

K/c/o Prostate Adeno CA with B/L Orchidectomy,Hyponatremia

P:-

Inv 

Sr sodium at 6:00pm

Rx 

1)IVF  3%NACL infusion @10ml/hr Till 6:00pm 

2)inj. LASIX IV 20 mg/IV /Bd

3)inj . PIPTAZ 2.25 gm/IV /TID

4)inj. PANTOP 40 mg /IV/OD .

5)GRBS  6th  hrly .

6)INJ. HAI S/C TID after informing PG  .

7)Tab Amlodipine 5mg/po/OD

8)Syp Lactulose 20ml /PO/HS

D A Y 3 (5/7/21)

S-stools passed twice .abdomen distension and pain abdomen relieved.

O - BP :  110/70

PR : 78

TEMP : 97.6 F 

Abd girth  91---57 cms.

Hb  6.9--  7.1---7.3----7.3

TLC   30,000,26,700--19000---21400 cells/cumm

Sr:

Serum

Urea:  121---111 --108---109

Creat  3.1 -3.1--3.3--3.3

Electrolytes

Na 130 --- 125--124--124

K  3.6--3.7---3.8---3.7

Cl  99--90---91--90

A- 

Post renal AkI on CKD.

Secondary  to BPH With B/L Moderate  hydronephrosis,

s/p TURP 2yrs back ---kims.

4 yrs back Kims 

K/c/o DM2 & HTN.(10years) 

K/c/o Prostate Adeno CA with B/L Orchidectomy,Hyponatremia

P

TREATMENT:

1) inj 3% Nacl 100ml@10ml/hr iv infusion 

2) syp LACTULOSE PO 20ML/HR

3)inj. LASIX 40 mg /wBd

4) inj . PIPTAZ 2.25  gm/IU /Stat.

5) inj. PANTOP 40 mg /PO/OD .

6)GRBS  6th  hrly pre meal.

7) INJ. HAI S/C TID agter informing PG  .

9) AMLONG  5 mg PO/ OD.

Treatment 

Day 0(2/7/2021)

Rx

1)Change FOLEYS  catheterization

2) IVF  0.9 %Nacl ( U.0+30ml/hr)

3)inj. LASIX IV 40 mg /Bd

4) inj . PIPTAZ 4.5  gm/IV /Stat.

5) inj. PANTOP 40 mg /IV/OD .

6)GRBS  6th  hrly .

7) INJ. HAI S/C TID after informing PG  .

8)  with hold OHA and Anti hypertensive

Day1

Rx 

1)IVF  0.9 %Nacl ( U.0+30ml/hr)

2)inj. LASIX IV 40 mg /Bd

3)inj . PIPTAZ 2.25 gm/IV /TID

4)inj. PANTOP 40 mg /IV/OD .

5)GRBS  6th  hrly .

6)INJ. HAI S/C TID after informing PG  .

7)Tab Amlodipine 5mg/po/OD

8)Abdominal girth measurement 2nd hrly

9)Proctolysis enema

10)Syp Lactulose 20ml /PO/HS

Day2

Rx 

1)IVF  3%NACL infusion @10ml/hr Till 6:00pm 

2)inj. LASIX IV 20 mg/IV /Bd

3)inj . PIPTAZ 2.25 gm/IV /TID

4)inj. PANTOP 40 mg /IV/OD .

5)GRBS  6th  hrly .

6)INJ. HAI S/C TID after informing PG  .

7)Tab Amlodipine 5mg/po/OD

8)Syp Lactulose 20ml /PO/HS

Day3

TREATMENT:

1) inj 3% Nacl 100ml@10ml/hr iv infusion 

2) syp LACTULOSE PO 20ML/HR

3)inj. LASIX 40 mg /wBd

4) inj . PIPTAZ 2.25  gm/IU /Stat.

5) inj. PANTOP 40 mg /PO/OD .

6)GRBS  6th  hrly pre meal.

7) INJ. HAI S/C TID agter informing PG  .

9) AMLONG  5 mg PO/ OD.7

10) 10) inj. OPTIEURON 1AMP  IN 100 MLNS  IV/OD.

11) CANDIN mouth paint. BD

Day4

S-  pt complaints  of burning  sensation in mouth.
O - BP :  100/60
PR : 84
TEMP : 98. F
Abd girth  91---87--86cms.
Hb  6.9--  7.1---7.3----7.3--6.8
TLC   30,000,26,700--19000---21400 --'
22,000 cells/cumm
Sr:
Serum
Urea:  121---111 --108---109--108
Creat  3.1 -3.1--3.3--3.3---2.5
Electrolytes
Na 130 --- 125--124--124---126
K  3.6--3.7---3.8---3.7-3.2
Cl  99--90---91--90---94


A-
Post renal AkI on CKD.

Secondary  to BPH C BL Moderate  hydronephrosis,

s/p TIRP 2yrs back ---kims.

C urosepsis 4 yrs back Kims

Kco DM2 & HTN. 

Bladder wash with 100 ml NS is done

1) inj 3% Nacl 100ml@10ml/hr iv infusion 

2) syp LACTULOSE PO 20ML/HR

3)inj. LASIX 40 mg /wBd

4) inj . PIPTAZ 2.25  gm/IU /Stat.

5) inj. PANTOP 40 mg /PO/OD .

6)GRBS  6th  hrly pre meal.

7) INJ. HAI S/C TID agter informing PG  .

9) AMLONG  5 mg PO/ OD.7

10) 10) inj. OPTIEURON 1AMP  IN 100 MLNS  IV/OD.

11) CANDIN mouth paint. BD.

Day 5

S-  pt C/O loose stools 10-15  times ,small quantity,non blood stained ,non foul smelling  since last night,
Decreased  urine output since yesterday.

Dehydration  is present. 
Abd distention decreased.
O - BP :  110/50
PR : 72
TEMP : 98. F
Abd girth  91---87--86--cms.
Hb  6.9--  7.1---7.3----7.3--6.8---7
TLC   30,000,26,700--19000---21400 ---
22,000 ----- 26,400  cells/cumm
Sr:
Serum
Urea:  121---111 --108---109--108--114
Creat  3.1 -3.1--3.3--3.3---2.5---3.2
Electrolytes
Na 130 --- 125--124--124---126--125
K  3.6--3.7---3.8---3.7-3.2--3.4
Cl  99--90---91--90---94--94


A-
Post renal AKI resolving, with UTI on CKD ,secondary to Diabetic Nephropathy 2o to BPH WITH BL MODERATE HYDRONEPHROSIS.

Hyponatremia. 
WITH BL ORCHIDECTOMY, S/P  TURP 2YRS BACK KIMS, 4URS BACK NIMS.
KCO  DM 2 ,HTN.
. 




TREATMENT:
1) IVF  0.9%  Nacl  0.0 + 30 ML /HR
2) inj. PANTOP 40 mg /PO/OD
3)T. SPORLAC  DS  PO  TID
4) inj . PIPTAZ 2.25  gm/IU / TID
5) T. AMLONG 5 MG  PO OD  8AM
6)GRBS  6th  hrly pre meal.
7) INJ. HAI S/C TID agter informing PG  .
9) INJ HUMAN MIXTARD S/C
    8am(  15IU ) -----x-----8pm (  12 IU )
Grbs   103   8 AM
10) BLADDER WASH DAILY ONCE
11) Strict I/O charting
12) Bp /PR/ T  daily charting
13) ORS  Sachets 2 in 1 water ,200 ml  after each ep.
14) CANDIN mouth paint
15)saline gargle BD.

Day 6

S-  pt C/O loose stools subsided,
Decreased  urine output since yesterday.
Abd distention present. Moderat eascites


O - BP :  110/50
PR : 62
TEMP : 98. F
Abd girth  91---87--86--99cms.
Hb  6.9--  7.1---7.3----7.3--6.8---7--6.7
TLC   30,000,26,700--19000---21400 --
22,000 ----- 26,400  ----22800 cells/cumm
Sr:
Serum
Urea:  121---111 --108---109--108--114--118
Creat  3.1 -3.1--3.3--3.3---2.5---3.2
Sr. Electrolytes
Na 130 --- 125--124--124---126--125--122
K  3.6--3.7---3.8---3.7-3.2--3.4--3.5
Cl  99--90---91--90---94--94---94


A-
Post renal AKI resolving, with UTI on CKD ,secondary to Diabetic Nephropathy 2o to BPH WITH BL MODERATE HYDRONEPHROSIS.
WITH BL ORCHIDECTOMY, S/P  TURP 2YRS BACK KIMS, 4URS BACK NIMS.
KCO  DM 2 ,HTN.
With dilution Hyponatremia (hypovolemia)
. 




TREATMENT:
1) IVF  0.9%  Nacl  0.0 + 30 ML /HR
2) inj. PANTOP 40 mg /PO/OD
3) inj . PIPTAZ 2.25  gm/IU / TID
5) T. AMLONG 5 MG  PO OD  8AM
6)GRBS  6th  hrly pre meal.
7) INJ. HAI S/C TID agter informing PG  .
9) INJ HUMAN MIXTARD S/C
    8am(  15IU ) -----x-----8pm (  12 IU )
Grbs   103   8 AM
10) BLADDER WASH DAILY ONCE
11) Strict I/O charting
12) Bp /PR/ T  daily charting
13) ORS  Sachets 2 in 1 water ,200 ml  after each
14)ascitic tap ,for culture,LDH, cytology
15)Lft, sr.ldh 

Day 7

S-  pt C/O pain abdomen.
0utput : 1000ml



O - BP :  120/60 mmhg
PR :  70 bpm
TEMP : 98. F
Grbs  239  mg dl
Abd girth  91---87--86--99----92cms.
Hb  6.9--  7.1---7.3----7.3--6.8---7--6.7
TLC   30,000,26,700--19000---21400 --
22,000 ----- 26,400  ----22800 cells/cumm
Sr:
Serum
Urea:  121---111 --108---109--108--114--118
Creat  3.1 -3.1--3.3--3.3---2.5---3.2
Sr. Electrolytes
Na 130 --- 125--124--124---126--125--122
K  3.6--3.7---3.8---3.7-3.2--3.4--3.5
Cl  99--90---91--90---94--94---94



A-
Post renal AKI resolving, with UTI on CKD ,secondary to Diabetic Nephropathy 2o to BPH WITH BL MODERATE HYDRONEPHROSIS.
WITH BL ORCHIDECTOMY, S/P  TURP 2YRS BACK KIMS, 4yRS BACK NIMS.
KCO  DM 2 ,HTN.
With dilution Hyponatremia (hypervolemia)
. 




TREATMENT:
1) IVF  0.9%  Nacl  0.0 + 30 ML /HR
2) inj. PANTOP 40 mg /PO/OD
3) inj . PIPTAZ 2.25  gm/IU / TID
5) T. AMLONG 5 MG  PO OD  8AM
6)GRBS  6th  hrly pre meal.
7) INJ. HAI S/C TID agter informing PG  .
9) INJ HUMAN MIXTARD S/C
    8am(  15IU ) -----x-----8pm (  12 IU )
Grbs   103   8 AM
10) BLADDER WASH DAILY ONCE
11) Strict I/O charting
12) Bp /PR/ T  daily charting
13) ORS  Sachets 2 in 1 water ,200 ml  after each