General medicine case 7

 November 24, 2021

70 YEAR OLD MALE WITH ALTERED BEHAVIOUR ?HYPONATREMIA

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 is welcome."

CASE:
 
A 70 year old male came with chief complaints of : 

1) Altered behaviour since afternoon.

2) Involuntary movements of the both upper limbs and lower limbs since 4pm along with loss of speech and involuntary movements of the mouth.

 HOPI: 
Patient was a security guard by occupation in Hyderabad 20 years back and his sons brought him to their village 20 years back and was doing nothing since then. He was normal till 1 month back and started developing decreased urine output, which was gradually progressive ,with poor stream of urine. No h/o of pedal edema, abdominal distension, SOB
He was taken to local hospital and was diagnosed with Renal failure ( creat 1.5 , with size of kidney 6cm with, Grade 1 prostatomegaly). He used the medication from the doctor only for one day and it did not gave him relief.
He used to take medication from RMP which used to increase his urine output for 4-5 days and gradually it decreases again , so when ever there is decreased urine output the patient attenders used to give a tablet and it increases his urine output and on 23rd November in the morning pt had complains of decreased urine output and his son gave one tablet and his urine output didn't increase, and he took one more tablet from his daughter in law and afternoon at 2pm when there was no one in the home , the neighbours watched him that he is using knife to cut on his abdomen to increase his urine output, being scared with his behaviour, the neighbours informed the attenders and attenders they returned home at 4pm in the evening and found that patient was having involuntary movements along with loss of consciousness and loss of speech.Then they brought to KIMS for further evaluation.

Past history:
He is a chronic smoker( since alduthood) 
- 2 to 3 / day

He takes alcohol occassionally

Vitals:
Bp- 170/90 mmhg
PR-73 bpm
Spo2- 98% at room air
Rr- 20 cpm
Temp- Afebrile



Haemogram: 




Complete urine examination:



 

Serum electrolytes:
Date:- 24/11/21


Date:- 25/11/21


Renal function test 



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