62 year old male with loss of appetite,sob and fever 

 CBBLE UDHC similar cases 

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT 

62 year male farmer by occupation came with complaints of loss of appetite since 20 days ,sob and fever, since 20 days. Vomiting since 2 days. ,Painful swelling in the left  gluteal region since 2 days and pain in the right hip region

HOPI : patient was apparently asymptomatic 20 days back then he went to outside private hospital with complaints of fever and sob and on investigation his creatinine 5.3 ,so sent for hemodialysis to our hospital.

C/o shortness of breath since 20 days  grade 4 ,no pnd and no orthopnea

Fever treated at outside private hospital 5 days back

Vomitings since 2 days, 2-3 episodes per day, food and water as content ,non projectile.

No decreased urine output.

Pain in the right hip region, pricking type radiating to the gluteal region 

Swelling in the left gluteal region of approximately 3x3 cms, solitary swelling,mobile

PAST HISTORY : 

H/o slip and fall 5 years ago and knee surgery was done and diagnosed with HTN and DM type 2 and he is on irregular medication.

He is diagnosed as ckd 2 years back

and managed conservatively but on irregular medication

Personal history: 

He is a chronic alcoholic and beedi smoker since childhood 6 beedis/day

HRCT done outside:

Areas of cystic bronchiectasis with fibrotic bands and adjacent pleural thickening in right upper lobe 

Fibroatelectatic changes in right upper lobe and right middle lobe

O/E

 pallor+ , no icterus ,clubbing,koilonychia,lymhpadenopathy,pedal edema

X ray chest

grbs charting

X ray hip

Surgery referal

ABG

 Vitals :

Temp:98.4f

Pr:82bpm

SPO2 :98%@ra

Bp:140/90mm hg

Rr :cpm

Grbs :160mg/dl

Treatment:

1 inj augmentin 1.2g iv/od

2 tab Azithromycin 500 mg po/od

3 inj lasix 40mg iv bd

4 tab atenolol 25mg po/od

5 tab nodosis 500mg po/bd

6 tab orofer xt po/bd

7 tab shelcal ct po/odp

8 neb with duolin and budecort @8th hrly

9 tab ultracet 1/2tab qid

10 monitor vitals

Diagnosis: chronic kidney disease secondary to diabetic nephropathy.with htn and DM since 5 years with cystic bronchiectasis , fibrotic bands in both upper lobeslobes right >left with no pleural effusion