65 yr old male with fever, anuria and vomitings.

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 Elog book also reflects my patient-centred online learning portfolio and your valuable inputs on the comment .



50 year old male, resident of Gundarampalli, cobbler by occupation.


Chief complaints - 

- Fever since 4 days (relieved on medication)
- Anuria since yesterday
- Vomitings 4 episodes, non projectile.

History of present illness - 

Patient was apparently asymptomatic 4 days back when he developed fever which is low grade, that is associated with chills, rigors. It is associated with an altered sensorium since 2 days.  He also had constipation associated since 2 days. He had left hypochondriac region pain since 2 days and Vomitings ( 4 episodes of non projectile vomiting) and anuria since yesterday.


Past history - 

- Diabetes mellitus since 3 years (on Glimipiride and metformin O.D)
- Hypertension since 15 years (telmisartan, amlodipine and hydrochlorothiazide O.D)
- No history of epilepsy, tuberculosis, thyroid disorders, asthma.

Personal history:

Mixed diet
Appetite is normal
Bowel and bladder - Constipated and anuria
Sleep is adequate. 
He is an alcoholic, occasional drinker.
He is a known smoker, occasional.
No known allergies. 



Family history: 
No similar complaints.



General Examination: 

Patient is examined in a well lit room after obtaining informed consent. He is conscious, coherent and cooperative, well oriented to time, place and person, moderately built and nourished. 

 No Pallor, Icterus, Cyanosis, Clubbing, generalized lymphadenopathy, Edema 



Vitals:

Temp.- 38 degrees Celsius 

BP- 110/70 mmHg

PR- 92 bpm

RR- 17 cpm



Systemic examination

CNS: 

Higher mental functions:

Oriented to time,place,person

Memory : Immediate,recent, remote intact

Speech: Normal

No delusions or hallucinations



Cranial nerves: 

1- normal

2- Pupillary reflex present

3,4,6- No restriction of movement of eye

5-normal( muscles of mastication+sensations of face)

7-Normal, wrinking of forehead seen, able to blow up cheeks

8- Normal hearing





Motor examination:



Tone - Normal in left upper and lower limb

Power-.                            Right      Left

             Upper limb          5/5        2/5

              Lower limb         4/5       3/5

Reflexes :
                                             Right.       Left
               
                    Biceps.             ++.             ++
                    Triceps.            ++.             ++
                    Supinator.        ++.             ++
                    Knee                  
                    Ankle 
                    Plantar.         flexion.      flexion



Cerebellum examination:

Able to do finger nose test.

Able to do dysdiadokinesia 

Gait: did not walk due to weakness





CVS: 

S1 S2+ no murmurs heard.



Respiratory system:

Bilateral air entry+ ,normal vesicular breath sounds-heard. 





Abdominal: 

Soft, non tender, no distension

No organomegaly

Bowel sounds heard.




Investigations - 









Provisional diagnosis - 

? Uremic encephalopathy
? Hypoglycemia with renal failure











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