General Medicine case 1
Aug 16,2021
This is an online e log book to discuss our patient de-identified health data shared after taking his /her /guardians signed informed consent.Here we discuss our individual patients problem through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evidence based input.
This e blog also reflects my patients centered online learning portfolio and your valuable inputs on the comment box is welcome.
Date of admission : 4 - 8 -2021
CHIEF COMPLAINT
A 45 yr old female, farmer by occupation, came to the casualty with a chief complaint of snake bite 7 days ago.
HISTORY OF PRESENT ILLNESS
Patient was apparently well one week ago.then on Wednesday she was bitten by a snake {Russel's viper} on the right foot and she was taken to the local hospital within 1 hr and Anti-Snake-venom was given.
She was fine for 1 day then she developed a swelling on her right lower limb and went to the local hospital , for which she was advised an ointment and the swelling subsided eventually.
After 3 days patient presented with 2 to 3 bilious vomiting with severe abdominal pain.
There is no necrosis around the bite.
No H/O palpitations , chest pain, photophobia, syncopal attacks , shortness of breathe.
PAST HISTORY:
There were no similar complaints in the past.no history of diabetic,nephropathy , hypertension, Epilepsy, Asthma,tuberculosis.
No history of any surgeries done.
PERSONAL HISTORY:
Patient takes mixed diet and has normal appetite .she has irregular bowel and bladder movements (constipation) . i
Micturition is normal.
No addictions.
TREATMENT HISTORY:
Patient is not allergic to any of the known drugs
GENERAL EXAMINATION:
Patient is conscious coherent and cooperative .
There are no signs of pallor, icterus, cyanosis, clubbing, generalized lymphadenopathy, pedal and bipedal edema
VITALS
Temperature: 98°F
Respiratory rate: 24 cpm
Pulse rate: 96bpm
Bp: 150/90
SpO2 : 99% at room temperature
SYSTEMIC EXAMINATION:
CVS :
S1 and S2 are heard
Respiratory system :
Bilateral air entry positive
No wheezing sounds
Trachea is at the center
ABDOMEN :
Distended , soft , tender
No palpable mass.
CNS:
Patient is conscious. Speech is normal.
No neurologic deficits
PROVISIONAL DIAGNOSIS :
Diagnosed as acute kidney injury with thrombocytopenia.
INVESTIGATIONS:
CBP :
Prothrombin time:
APTT
RFT
TREATMENT
1. Foley's catherization for output monitoring
2. Oral fluids 3lites/ day
3.injection lasix 40mg / BD
4. Strict I/0 monitoring
5. Inj PAN iv/ OD
6. Inj zoffer 4mg/ iv
7. Inj Buscopan IM/ BD.
Questions
Sir,Nephrons have limited regeneration capacity and patient had actually undergone dialysis...and now she is getting discharged..will she be alright? doesn't she need a transplantation...
In case of acute kidney injury will both kidneys get damaged to the same extent?
Will the patient be on regular dialysis?
Will tha patient be okk or will she face kidney related problems in the future?
Is there any possibility that the patient can have other complications related to snake bite in the coming future?
Comments
Post a Comment