A 67Yr Old male with burning micturition and decreased urine output.

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A 67 year old male, weaver by occupation came to causality with 

#CHEIF COMPLAINTS:- 

(1)Decreased urine output,

(2) Burning micturition and

(3) Lethargy since 15 days.

#HOPI:

*Patient was apparently asymptonatic one year back ,then he started experiencing altered sleep cycle.

*He was also experiencing episodes of Nocturia in this one year. 

*Patient had c/o   urinary Incontinence since 1 year. 

*Patient had recurrent episodes of UTI (in the past 1 year). Because of his urinary incontinence, patient totally avoided social gatherings in the past 1 year.

*15 days back he had 2 episodes of vomitings, 4-5 episodes of loose stools.

*He had two episode of vomiting non-bilious, non-projectile, containing food particles. He had 4-5 episodes of loose stools per day. 

*He had burning sensation in the tongue and throat  since 15 days,so that he was taking only minimal water and milk. 

*Patient had decreased urine output and whenever he tried to micturate associated with burning sensation in the penis, which lasted for 20mins. Because of this symptom (dysuria) he totally decreased intake of fluids so that he won't get painful urination. 

*Whenever he passes urine, it totally amounts to 10ml. 

*10 days back he experienced dysphagia for which he was hospitalised and was Managed for the same. 

•History of fever on and off

•No history of dyspnoea, SOB palpitations ,chest pain& PND.

•No history of abdominal pain, distension. 

•History of burning micturition present, •H/O pyuria present.

#Past history:

•N/A/K/O HTN, DM, HYPOTHYROIDISM, CVA, EPILEPSY

•H/O cataract surgery 2 months back.

#Personal History:-

•Diet - mixed

•Apeptite-decreased

•Bowel and bladder - regular

•Sleep - inadequate

•Addictions:-Alcoholic since 20 yrs,takes quarter daily.stopped 10 days back.

#FAMILY HISTORY:

No significant family history.

#GENERAL EXAMINATION: 

O/E : Patient is C/C/C

Clubbing - Absent

Pallor - present

Icterus  absent

Cyanosis - absent

Edema of feet - absent

Lymphadenopathy  - absent

VITALS:- 

 BP: 100/70mmhg

 PR: 96 bpm 

 RR: 20cpm 

 Spo2: 97%

GRBS: 79 mg/do

#SYSTEMIC EXAMINATION : 

CARDIOVASCULAR SYSTEM : S1 and S2 heard, no murmurs heard 

RESPIRATORY SYSTEM : BAE present, NVBS heard, position of trachea - central

PER ABDOMEN : soft, non tender.

No organomegaly.

CNS: Higher mental function intact,NAD.

Above Pics Acknowledged from -Saketh vandan-174 Intern Sir.

#Previous reports:

12/12/2020

Hb- 13.6gm/dl

Total counts- 5,700 cells /cumm

Platelets- 3.5 lakhs

Rbs-114

13/12/2020

S. Creat-3.6mg/dl

CUE:

Pus cells- plenty

RBC- nil

EC- 2-3

22/3/22

Blood urea- 203 mg/dl

S.creat-8.4mg/dl

Abg:

PH- 7.13

PCO2- 5.6mmHg

PO2- 135mmHg

HCO3- 1.8mmol/L

23/3/22

Blood urea-190mg/dl

S.creat-8.3mg/dl

Abg:

PH- 7.17

PCO2- 8.6mmHg

PO2- 138mmHg

HCO3- 3.1mmol/L

24/3/22

Blood urea- 136 mg /dl

S.creat- 6.2mg / dl

Abg:

PH- 7.2

PCO2- 8.8mmHg

SpO2- 96.1%

HCO3- 3.5mmol/L

23/3/2022

#HEMOGRAM:-

HB :- 6.9gm/dl

Wbc:- 6,800 cells/cumm

Neutrophills :- 60%

Lymphocytes :-30%

Eosinophills:- 6%

Monocytes:-4%

Basophills:-0%

PCV :- 21.2 VOL %

MCV :- 105.5 fl

MCH:- 34.3 pg

MCHC :- 32.5%

RDW -SD :- 59.7fl

RDW -CV :- 15.3%

RBC :- 2.01 Millions/cumm

PLATELETS :- 2.32 Lakhs/cumm

ON-22/3/2022

LIVER FUNCTION TEST (LFT) :-

Total bilirubin :- 0.97mg/dl

Direct bilirubin :- 0.26mg/dl//

SGOT(AST) :- 15 IU/L

SGPT(ALT) :- 10 IU/L

Alkaline phosphatase :- 212 IU/L

Total proteins :- 7.3gm /dl

ALBUMIN :- 2.67 gm/dl

A/G Ratio :- 0.58

ON-23/3/2022

SERUM ELECTROLYTES:-

Sodium :- 142 meq/l

Potassium :- 4.4 meq/l

Chloride :- 104 meq/l

INVESTIGATION:-

USG:-

On 20-12-2019

On 18-10-2021

On 23-02-2022

X-RAY:-

ECG:-

2d-ECHO:-ON 23-03-2022

#Diagnosis:

*Recurrent UTI secondary to ?Renal calculi

•AKI ON CKD

•metabolic acidosis

•Normochromic Normocytic anemia(2o to CKD)

#TREATMENT:

1. IVF NS & RL @100ml/hr

2. Inj. Monocef 1gm/po/nd

3. Inj. Pan 40 mg/iv/of

4. Mucopain gel oinent for L/A

5. GRBS 6th hourly

6. Vitals monitoring 4th hourly