unit 3 medicine case hyponatremia
Hellooo everyone... I am Dr.Srujana Reddy Kondamadugula , an intern posted in General Medicine department & one of the important terms of getting the internship completion is to complete my log book with my online log of what I learn during the course of my duties.
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 patient's clinical problems with collective current best evidence based inputs.
This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.
Here is a which I have seen
A 70 yrs old female patient came from a village, in mid southern india came to casuality on 26/08/2020 with cheif complaints of pain abdomen & headche , decreased urine output since 5 days & vomitings since last night .
15 yrs back she went to a local hospital for excessive menstrual bleeding for duration of 3 months & was Hysterectomised ; at that time she was diagnosed as denovo hypertensive was started& on medications but she took irregularly ( tab. Olmesartan, tab. Medoxomil 20 mg, tab. Amlodepine 5 mg, tab hydrochlorthiazide 12.5mg) .
5 days back she developed pain abdomen in epigastric region, colicky type of pain ,non radiating. Along with headache, & decreased urine output.
3 days back she developed burning Micturition.
Last night she developed vomiting 1 episode bilious, & non - projectile type, nausea was present. Followed by decreased appetite.
No h/o blurring of vision, loss of consciousness, involuntary movements, pedal edema, shortness of breath, chest pain, palpitations, loose stools.
She is not a k/c/o DM, asthma, TB, CAD, CVA, epilepsy.
General examination :
On examination pt is conscious, coherent, cooperative, oriented to time, place & person, moderately built & nourished.
Vitals :
BP : 150/100 mmhg
Pulse: 84bpm
Saturation: 99%
Temperature: Afebrile
GRBS: 87mg/dl
RR : 20 cpm
No pallor, icterus , clubbing, cyanosis, koilonychia, lymphadenopathy & pedal edema .
Systemic Examination :
CVS : S1 & S2 heard, No murmurs.
Respiratory system : bilateral air entry present, trachea central, normal vesicular breath sounds heard, no adventitious sounds heard.
Per abdomen:
Shape of abdomen: scaphoid,
No tenderness and local rise of temperature,
No palpable masses.
Hernial orifices normal.
No free fluid and bruit.
Liver and spleen : not palpable.
Bowel sounds: normally heard.
CNS :
Higher Mental Functions: patient is concious, coherent, cooperative, oriented to time, place & person.
Speech is normal in pitch & tone .
Memory : recent & remote memory intact .
Cranial nerves : all cranial nerves intact.
Motor System :
Tone : UL LL
Rt N N
Lt N N
Bulk :
Rt N N
Lt N N
Power :
Rt N N
Lt N N
Hand grip: 100% 100%
Sensory system :
Rt Lt
Fine touch N N
Crude touch N N
Pain/temp N N
Vibration N N
Joint position N N
Proprioception N N
Reflexes :
Superficial reflexes :
Rt Lf
Corneal Present present
Conjunctival present present
Abdominal present present
Plantar flexor flexor
Deep tendon reflexes :
Rt Lt
Biceps ++ ++
Triceps ++ ++
Supinator ++ ++
Knee ++ ++
Ankle ++ ++
Cerebellum : No finger nose incoordination
Kneel heel test : normal
No signs of meningeal irritation
GCS : 15/15
Provisional diagnosis : Pain abdomen ? Renal caliculi , with incidental detection of drug induced hyponatremia.
Investigations
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Treatment:
Pt attenders were counselled adequately about her condition and course of disease in their own language and the difficulty in managing .
IV Fluids 0.9% NS continuos infusion @ 100 ml/hr .
Inj. PAN 40 mg / iv/ OD
Inj. ZOFER 4mg / iv/ TID
Tab. AMLONG 5mg OD
Inj. BUSCOPAN 2cc/IM/SOS
ORS sachets in 1 lit water.
Monitor BP, PR, RR.
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Investigations
USG abdomen : Rt Renal caliculi .
Monitor BP, PR, RR.
Monitor BP, PR, RR.
Monitor BP, PR, RR.
Monitor BP, PR, RR.
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Investigations :
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