70/ M with HYPONATREMIA - EUVOLEMIC? SIADH? TB K/C/O HTN

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. 

Here is a case I have seen. 


INTERNS 
juveria 
Swarna 
Nikhil 
Divya


Dr. Arjun. (ASSIS PROF) 
PGs
Dr. Manasa PGY1
Dr. RADHA PGY3


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


70 / M , rice mill worker by profession , complains of vomiting : 6 to 7 episodes /day immediately after food , non bilious. 

Cough with sputum since 10 to 15 years on and off 
Decreases urine output with decreased stream. 
No H/ O burning misturation 
No other complaints of chest pain , pedal edema , facial puffiness 
No H/O fever, loose stool , no other complaints

No similar complaints in the past 
H/O HTN since 25 years , on medication 
AMLONG -AT 5/50 mg OD.
No H/O DM , asthma, epilepsy, thyroid, or any surgeries in the past. 

Personal history 
Married, appetite normal, is on non veg diet, with regular bowel and bladder movements , habits: beedis ;chutta 1 pack per day since 30 years.... Sleep is adequate 

General examination 
Patient is conscious ,coherent ,coopertive 
Moderately built and nourished

No pallor,icterus  ,clubbing ,cyanosis,generalised edema and lymphadenopathy. 
Vitals 
Pr:60bpm
Bp: 110/70mmhg
Grbs :94mg/dl
Cvs : S 1, S 2 HEARD , no 

Respiratory examination :
Bilateral air entry present , normal vesicular breath sounds 
Abdomen is soft and non tender 

CNS examination: 
oriented to time place person he is alert conscious coherent cooperative , 
cranial nerves intact
Sensory and motor system examination is 
normal
no signs of meningeal irritation
 no cerebellar lesions. 

INVESTIGATION
On 14th 

on 16/3/21


Treatment 
IVF 3 % Nacl continues infusion at 15 ml / hr. 
INJ. PAN 40 mg IV /BD 
TAB. AMLONG 5mg /PO/ OD 
Inj. Ceftriaxone 1gm / iv/bd 
Tab. Azithromycin 500 mg /od 
Strict input output charting. 

Day 2 

Fluid restrictions <1 litre/day
IVF 3 % Nacl continues infusion at 10ml / hr. 
INJ. PAN 40 mg IV /BD 
TAB. AMLONG 5mg /PO/ OD 
Inj. Ceftriaxone 1gm / iv/bd 
Tab. Azithromycin 500 mg /od 
Strict input output charting. 
Syrup ambroxol 10ml /PO/TID 

Day 3 

Fluid restrictions <1 litre/day
INJ. PAN 40 mg IV /BD 
TAB. AMLONG 5mg /PO/ OD 
Inj. Ceftriaxone 1gm / iv/bd 
Tab. Azithromycin 500 mg /od 
Strict input output charting. 
Syrup ambroxol 10ml /PO/TID 

Day 4
Fluid restrictions <1 litre/day
INJ. PAN 40 mg IV /BD 
TAB. AMLONG 5mg /PO/ OD 
Inj. Ceftriaxone 1gm / iv/bd 
Tab. Azithromycin 500 mg /od 
Strict input output charting. 
Syrup ambroxol 10ml /PO/TID 
Syrp POTCHLOR 15 ml in one glass of water /tid 
Tab. Tolvaptan 15 mg /po/od 

Day 5 
Salt restriction <2.4g/day
Fluid restrictions <1.5 litre/day
INJ. PAN 40 mg IV /BD 
TAB. AMLONG 5mg /PO/ OD 
Inj. Ceftriaxone 1gm / iv/bd 
Tab. Azithromycin 500 mg /od 
Strict input output charting. 
Syrup ambroxol 10ml /PO/TID 
Syrp POTCHLOR 15 ml in one glass of water /tid 
Tab. Tolvaptan 15 mg /po/od 

Day 6 
Salt restriction <2.4g/day
Fluid restrictions <1 litre/day
INJ. PAN 40 mg IV /BD 
TAB. AMLONG 5mg /PO/ OD 
Inj. Ceftriaxone 1gm / iv/bd 
Tab. Azithromycin 500 mg /od 
Strict input output charting. 
Syrup ambroxol 10ml /PO/TID 
Syrp POTCHLOR 15 ml in one glass of water /tid 
Tab. Tolvaptan 15 mg /po/od 





Popular posts from this blog

56/M with CKD

Image
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. Here is a case I have seen.  INTERNS  juveria  Swarna  Nikhil  Manivarma Divya PGs Dr. HAREEN (SR)  Dr. Praneeth Y3 Dr. Vaishnavi Y2 Dr. Vinay Y1 56 year old male, stopped working 1 year back, came with chief complaints of shortness of breath since 3month.  Pedal Edema since 3months Decrease in urine output since 3 months.  HOPI: patient was apparently asymptomatic 9 months back. He developed shortness of breath 3months back,initially it was present on walking for some dis
Read more

45/F with anaemia? IDA.

Image
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. Here is a case I have seen.  INTERNS  juveria  Swarna  Nikhil  Manivarma Divya PGs Dr. HAREEN (SR)  Dr. Radha PGY3 Dr. Vaishnavi PGY2 Dr. Vinay PGY1.   Patient was apparently asymptomatic one and half year back then she complain of pedal edema one and half year back which is pitting type ,not aggrivated or relieved on medication.  Complain of SOB grade 3 on walking some distance and relieved on medication at hospital.  Also complain of facial puffiness and relieved on medi
Read more

Bimonthly assessment for the month of MARCH

Image
Bimonthly assessment for the month of March 2021 This is my submission for the Bimonthly internal assessment for the month of March. The questions to the cases being discussed can be viewed in the following link :  https://medicinedepartment.blogspot.com/2021/03/medicine-paper-for-march-2021-bimonthly.html?m=1 1Q.  Link to the following question :  https://ashakiran923.blogspot.com/2021/03/60-years-old-male-fever-under-evaluation.html?m=1 A)   What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?How specific is his dilated superficial Abdominal vein in making diagnosis? Problem presentation :  • Fever since 15 days - not ass. with chills and rigor, intermittent type, taken medication which got relieved. • Shortness of breath since 3 days, progressed from grade 2 to grade 4.  • Burning micturition + (duration - not given ) • No h/o palpitations, chest pain, orthopnoea, PND, pedal Edema .  No h/o
Read more