60yr old female with chronic kidney disease caused by NSAID abuse

A 60 yr old female laborer came to general medicine OPD with chief complaint of pain in lower back since 3yrs.

Patient came to hospital on 21/12/22 and was admitted on 22/12/22

History of Presenting Illness
Patient was apparently asymptomatic 3 yrs ago she then developed severe lower back pain that was continuous. It was dragging type of pain. There was no aggravating or decreasing factors. Due to the pain the patient would take self prescription of dolo (paracetamol 650mg ) , twice a day. This happened for the past 3 years.
H/O bilateral pedal edema
Patient complained of burning micturition since the past 15days 

Follow up- 
5/1/23
Patient complains of no sleep.

Past History
No similar complaints in the past
NO history of surgeries
No history of blood transfusion
Not a known case of Hypertension, Diabetes mellitus, bronchial asthma TB, epilepsy.

Personal History 
Mixed diet
Decreased appetitie
Burning Micturition
Normal Bowel movements
Inadequate sleep
No addictions

Family History
Mother had Diabetes mellitus

Drug History
used to take dolo 650 twice a day for back pain

Allergies
No known allergies to food or drugs

General Examination
Patient was conscious, coherent, and cooperative, well oriented to time, place and person.
Examined in supine position.
Obese and well nourished
No Pallor 
No Icterus
No Cyanosis
No Clubbing of fingers
No pedal edema
No generalized lymphadenopathy

Vitals 
Temperature- 98.6F
Pulse Rate- 78 beats/min
Respiratory Rate- 16 breaths/min
Blood Pressure- 160/80 mm of Hg
Oxygen Saturation- 98%
GRBS- 119 mg%

Systemic Examination
Cardiovascular
No thrills or murmurs
S1 and S2 sounds present

Respiratory
No dyspnea or wheezing
Trachea central in position
Breaths sounds - vesicular

Abdomen
shape- obese
No tenderness
No palpable mass
No organomegaly

CNS
Conscious
Speech is normal
No neck stiffness

Investigations
21/12/22



22/12/22









23/12/22







24/12/22








25/12/22

26/12/22





27/12/22





30/12/22


1/1/23


3/1/23




Prescription:
Inj Lasix 40mg x3
Tablet Nicardia 10mg x3
Syrup ceemaffin 10ml
Tablet sobouis 50mg

Diagnosis
Chronic Kidney disease due to chronic NSAID use. Denovo Hypertension case.

















































Comments

Post a Comment

Popular posts from this blog

60yr old male with ascites

60yr old male shop owner from kammareddygudem came to GEN MED OPD with chief complaint of bloating of stomach since 6 days  Patient was admitted on 23/12/22 HOPI patient was apparently asymptomatic 1 week ago. He then developed bloating of the abdomen, it was associated with poking type of pain. the pain did not have any aggravating and decreasing factors. Pain was also observed when patient would sit up from a lying down position. Patient complained of polyuria and polydypsia since 6days. Negative History  No nausea No vomiting's No Headache No Anorexia No giddiness No burning micturition  No constipation  No diarrhoea  Past History  5 yrs ago patient was diagnosed with decompensated liver disease 3yrs ago endoscopy showed esophageal varices, as treatment elastic bands were placed to prevent further bleeding. Diabetic since 3yrs  4 months ago the patient went to warangal hospital with similar complaints , there he was diagnosed with ascites and an asictic tap was done, and the pat
Read more

55 yr old male with cerebrovascular accident

55 year old male with Cerebrovascular accident  December 26, 2022  55 year old male a goat Heder from Gouraram came to the department on  23/ 12 / 2022  with chief complaints of weakness in left upper arm associated with sudden involuntary moments.  HOPI - Patient was asymptomatic 10 days back. On 17/ 12/ 22 he developed sudden involuntary moments on the left upper limb associated with weakness and loss of speech. The patient was taken to a hospital in nalgonda where he was admitted and the following tests were done-  -MRI brain -CBP -Echocardiogram  - Lipid profile  - CT cerebral angiogram  - ECG -LFT - CT neck angiogram  -Renal function test  The following medication was prescribed-  - Metformin hydrochloride sustained release tablets ip - 500mg - Atorvastatin tablets ip- 40mg - pantopazole gastroresistant - 40mg and domperidone prolonged release 30mg gelatin capsule. - clopidogrel - 75mg and aspirin - 150mg capsules  - Cefixime and Lactic acid bascillus dispersable tablets  - Telmis
Read more

40yr old female with psychosis

Image
A 40 yr old female was brought to the General medicine OPD by her husband with chief complaints of abnormal behavior since one week. patient was admitted on 27/12/22 History of Presenting Illness Patient was asymptomatic 2 weeks ago she then suddenly starting exhibiting abnormal behavior. She was shouting and was saying that she heard voices talking bad about her. 1 Male and and 2 female voices were heard. She also said that her husband was talking bad about her character. She was saying that her husband was spreading information that she didn’t tell him. These small episodes occurred randomly throughout the day and had no pattern or any triggering factors. Patient was not able to do her normal work during such episodes. She was not aware of her abnormal behaviour.                                                  Follow Up 3/1/23 - Patient did not have any psychotic episodes. She ate well and also had  no sleep disturbances. Patient complaint of dizziness. Past history  No similar comp
Read more