26M with pedal edema and SOB.

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A 26y Male patient presented to OPD with complaints of Pedal edema since 8 months and Shortness of breath since 8months.

The patient was apparently alright 10yrs back following which he developed fever and generalised weakness and then he diagnosed with Diabetes which is managed with Insulin since then. 





The patient developed blebs on Right lower limb associated with fever 1year back for which some intervention was done and which healed eventually. 



8months back he developed pedal edema and fever with shortness of breath on exertion and decreased urine output and then diagnosed to have renal problem (in attenders language). Where first dialysis was done. 

Since then the patient was on regular hemodialysis with frequency of 2-3 dialysis for week since 8months with intermittent SOB and pedal edema. 

3months back the patient shifted to nearest town for dialysis for which a Right Subclavian central line was placed and dialysis is being done through it since 3months.

Patient presented with SOB and abdominal discomfort and pedal edema 6days back then he was admitted and dialysis was done and sent to home on day care basis. Patient came for next dialysis with loss of appatite and abdominal discomfort and low grade fever. Since 2 days he was drowsy but Aurosable pupils was reactive and oriented to time place and person. 

As the patient drowsiness worsens and vomitings of 2 episodes with food particals as contents. With altered sensorium the patient was shifted for dialysis. 

After dialysis the patient drowsiness was not improved and Immediate CT was done. 

O/E

Pt is drowsy but Arousabled. 

GCS after dialysis was E3V1M1

Tone                       Rt       Lt

Upper limb            dec    dec

Lower limb             dec   dec

 Reflexes

Corneal                   -           -

Conjunctival          -            -

Biceps                     +           ++

Triceps                   -              +

Knee                       -               -

Ankle                     -               -

Plantars           flexion         flexion


Labs: 

Day 1





Day 3



Day 5












Summary

A 26M with CKD on MHD with Anemia and Diabetes with Hyperdense lesions in pons and chronic lacunar infarcts. 


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