50 year old male with CKD

50 year old male with CKD - Prefinal

April 23, 2023

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Chief complaints:

1) Itching since 2 months

2) Decreased appetite associated nausea and vomting since 7 days .

3) Decreased urine output since 1 day.

History of present illness :

50 year old male who is a lorry driver by occupation.He was uneducated,till 13 years of age he used to help his father in agriculture farming and then worked as a lorry cleaner for 2 years and later as lorry driver for 30 years.

At 13 years of age, patient got married and

15 years of age, patient started driving the lorry , used to earn his living.

He used to drive lorry for 1 month continuously and take rest for another 1 month at home.

At 25 years of age ,his first daughter was born and after 3 years his younger daughter was born

He used to smoke 5-6 beedis per day and used to take alcohol more than 90ml per day.

With the money earned through lorry driving ,he bought a agriculture land ,where his neighbours used to take care of his land.

5 years of back, patient developed generalised weakness for which he went to the hospital and found to diabetic and started on OHAs and irregular medication.

After 1 year because of uncontrolled sugars, patient was started on Insulin , but he took only one dose because of fear of hypoglycemia.

patient had thorn pick on the right foot and injury to the left 2nd toe with slippers following which patient blebs , and later it got amputated .

And 1 year back on routine follow up, patient was told to have renal failure and started on conservative management.

Since 2months , patient started developing itching which started over the back, then all over the body including buttocks.

Since 7-10 days onwards patient started having decreased appetite with nausea and vomting and decreased urine output for 1 day and then came here for further evaluation.

Past history:

Known case of Diabetes since 5 years

Known case of Chronic kidney disease since 1 year.

Past history of cataract surgery to the right eye 3 years back.

On examination:

Sensory :

Dorsal column:

Upper limb:

Vibration:6 seconds

Fine touch: present

Proprioception: present

Lower limb