UREMIC ENCEPHALOPATHY WITH AKI ON CKD

 CASE SCENARIO:

A 75 year old male patient came to casuality in unresponsive state since 1 hour.

Patient was having fever since 10 days .

HISTORY OF PRESENT ILLNESS:

The patient was apparently 

 asymptomatic 10days back then he had insidious onset of fever ,low grade intermittent ,releived with medication,not associated with any chills and Rigors.

Yesterday morning he woke up,done his routine works and was normal till evening ,went to sleep and they tried to wake him up,as the patient was unresponsive.

4 months back patient wide was demised ,from then he was not interacting actively with his family members and having excessive sleep 

Patient attendees are saying that patient had h/o wt loss 

Patient had h/o left sided scrotal swelling since 6 years

 

HISTORY OF PAST ILLNESS:

No h/o diabetes ,HTN,Asthama ,TB and epilepsy 

PERSONAL HISTORY:

Appetite -decreased since two months 

Sleep -excess

Bowel and bladder movements -normal nd regular 

Addictions -none 

FAMILY HISTORY

Not significant

GENERAL EXAMINATION:

No icterus, clubbing, lymphadenopathy, edema, pallor, cyanosis,kolionychia

SYSTEMIC EXAMINATION:

Glasgow sacale: E1,V1M1

BP-140 systolic 

PR-42/min,regularly,irregular 

RR-BLAE present

CVS :

 S1S2 HEARD 

no thrills no murmurs

ABDOMEN:

Non distended

Diffuse tenderness absent 

Guarding and rigidity absent

CNS-

                  Right         Left 

Tone  UL.  Hyper        Hypo 

           LL.  Hypo         Hypo 

Power  UL  -                 -

             LL  -                 -

Reflexes-

            B-   ++       ++

            T-   ++       ++

            S     ++      ++

            K-    +         -

            A-    -          -

            P- extensor extensor

INVESTIGATION

 

PROVISIONAL DIAGNOSIS- Uremic encephalopathy with AKI on CKD