60/ M /CKD with altered sensorium/thesis short case

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Chief compliants: 

Altered sensorium since morning.

History of present illness : 
Patient is a labour by occupation used to work in the agriculture fields.He also had 1/2 acre land where he grows paddy and married at around 25 years of age.After marriage , when he was working in the field ,he had injury by cow on his chest , which later on formed a keloid on his chest.
4 years back, patient developed generalised weakness for which he went to the hospital and diagnosed to have Diabetes and Hypertension and started on medication.
He continued working for 3 years and eventually stopped going to the work and only took care of his own paddy field.

10 days back, patient developed altered behaviour, saying bad words to his wife and difficulty in recognising the attenders and then went to private hospital, and discharged after 2 days and patient was normal up to 3 days and after 3 days, patient was unable to get up from his bed and altered and brought to our hospital,where his grbs was found to be 20mg/dl.and after correction with 25% dextrose his sensorium improved.

In view of deranged renal parameters and continuous hypoglycemia , sepsis patient was taken for hemodialysis on admission.

Investigations: 

Maraiah 

RFT 
UREA - 104 
CREATININE - 5.9
URIC ACID -4.7
Ca- 8.6 
PHOSPHORUS-3.9 
Na - 135
K+ - 3.7 
CL - 103 

Serology 
HIV - NEGATIVE 
HBSAg - NEGATIVE 
HCV - NEGATIVE 


BLOOD GROUPING - B POSITIVE
 
USG ABDOMEN - 
IMPRESSION- 
GRADE 1 RPD CHANGES NOTED IN BILATERAL KIDNEYS 

14/6/23 
BLOOD UREA - 141 

14/6/23 
Na- 140
K+ - 3.7 
Cl- 99
CALCIUM IONIZED - 1.09 

14/6/23
SERUM CREATININE- 7.7 

LFT - 
TB - 0.64
DB - 0.19 
SGOT - 37 
SGPT - 30
ALKALINE PHOSPHATE- 374 
TB - 5.8 
ALBUMIN - 3.1 
A/G RATIO - 1.13

Chest X ray: 


ECG : 



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