A 28 year old male patient came to the OPD with the chief complaints of seizures episodes.
28year old male with ureamic encephalopathy with CKD on maintenance hemodialysis
January 12, 2022.
28 year old male pt , resident of nalgonda district who is a sales man in cloth store, presented to casualty on 22/12/21 with the chief complaints of
A. H/o fever 1 week back associated with chills .
B. H/o sob since 10 days, grade II - III.
C . H/o chest pain since 3 days.
Negative history
No H/o hematuria , frothy urine, nausea, loose stools, decreased urine output, pedal edema.
( but there is history of vomiting during dialysis on 23rd)
History of present illness:
Pt was apparently asymptomatic 10 months back (in February) then
1) he noticed sudden loss of weight of about 10-15kgs, in a span of 1 & 1/2 months for which he consulted local doctor where he was diagnosed to have CKD and his creatinine levels are high
2) for which he was advised to undergo dialysis I /v/o high creatinine levels.
3) he went to other hospital in Hyderabad and they tested and told him he has HYPERTENSION along with decreased kidney size and suggested dialysis
4 ) he came to our hospital for dialysis , here he tested COVID-positive in APRIL 2021 , then he came back for dialysis after 2 months on JUNE 24TH
5 ) K/c/o CKD since April 2021 and is on MHD since June underwent 27 sessions of hemodialysis., Discontinued from 19/10/21 ( SEPTEMBER)
6) then he presented with fever, seizures on DECEMBER, where the dialysis was done 5 sessions till 10 / 1 / 22
He had a altered behaviour....and confusing about place and trying to take the cannula on the 3 to 4 days of admitting ( 22/ 12 / 21 )
Past history :
K/c/o HTN +.since 8 months.
Not a k/c/o DM, CAD, ASTHMA, TB.
Personal history:
Diet: mixed .
Appetite: reduced
B&b: regular.
Sleep: adequate.
No significant family history.
General examination:
Pt was examined in well illuminated and ventillated room with his and his guardian consent.
Pt is c/c/c well orientated to time,place and person, moderately built with mild dehydration.
A ) Pallor-present, B) no signs of icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.
C ) Temp: 98.6 f
PR: 88 bpm
RR: 30 cpm
BP: 160/100 mm hg
SpO2: 98% @ RA
GRBS : 130 mg%
CVS: S1, S2+ no murmurs
RS: BAE+, NVBS+
Pleural rub is present
Bilateral basal crepitus is seen
P/A: SOFT, NON TENDER.
CNS: PT IS CONSCIOUS
SPEECH: NORMAL
NO SIGNS OF MENINGEAL IRRITATION.
REFLEXES: R. L.
B. 2+. 3+
T. 3+. 3+.
S. -. 3+.
K. 3+. 3+
A. -. -.
P. REDUCED
POWER: R. L.
UL. 5/5. 5/5
LL. 5/5. 5/5
TONE:. R. L.
UL. N. N.
LL. N. N.
Gait: normal
Provisional diagnosis : UREMIC ENCEPHALOPATHY WITH CKD ON MHD
CKD ON MHD WITH DIALYSIS DYSEQUILIBRIUM SYNDROME, WITH HYPERTENSIVE NEPHROPATHY WITH K/C/O HTN.
Clinical pictures:
