55yr old with h/o anuria and fever

 

 Chief complaints 

A 55 year old female presented to casualty with c/o of anuria since yesterday night 

HOPI-

Patient was apparently asymptomatic 1 year ago , when her sister died she cried a lot , felt weak and was taken hospital , routine investigations were done and was told she had kidney problem and was referred to kamineni I/v/o dialysis and was admitted for 2 sessions of dialysis .Urology opinion was taken for ?obstructive uropathy , ?kidney operation was done ,used medication for 3 months and the symptoms were relieved 

H/o nsaid use for 1year h/o pedal edema and facial puffiness 6 months ago .

Sob not present 

Comorbities - hypertensive since 6 months 

Headache (frontal since  2 months )

H/o fever since 4 days associated with chills 

H/o anuria since 1 day 

H/o vomitings 1 episode (non projectile,non bilious ),food as contents 

No h/o hematuria , frothy urine 

No h/o cold , cough , loose stools , burning micturition 


Family history 

Not significant 


Personal history 

Occupation -farmer 

Daily routine -work in the morning , takes staple food as breakfast , at 1 pm she eats lunch (rice)

Diet -mixed 

Appetite -normal 

Sleep -adequate 

Bowel habits  -regular 

Addictions -h/o toddy intake since 15 years 


General examination 

Patient is c/c/c 

Bilateral pedal edema +

NO   icterus ,cyanosis , clubbing , lymphadenopathy 

Pallor + 

Temp -100 degree f

BP -140/90 mmhg

PR -92 BPM 

SPO2 -98 %@RA 

RR -18 CPM 


Systemic examination 

CVS - s1 s2 + , no added murmurs 

Rs - nvbs +

P/a -soft , non tender , no organomegaly , bowel sounds +

CNS - no focal neurological deficits present 








INVESTIGATIONS -

RFT,LFT,CBP 

 TREATMENT GIVEN 

1.IVF NS AND RL 30 ML /HR URINE OUTPUT +

2.INJ.PANTOP 40 MG/IV/OD

3.INJ.ZOFER 4 MG/IV/BD

4.INJ.LASIX 40 MG/IV/BD

5.TAB.NODOSIS 550 MG/PO/BD 

6.TAB.SHELCAL 50P MG/PO

7.TAB OROFER /PO/OD

8.STRICT I/O CHARTING 

9.TAB.PCM 680 MG/PO/SOS

10.INJ.NEOMAL 1 GM/IV IF TEMP > 101.1 F

11.MONITOR VITALS hourly 

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