26yr male with vomiting

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. 

Case presentation:

26yr old male k/c/o dm since 10yrs (diagnosed at the age of 15yrs with symptoms of polyuria, polydipsia), HTN since 6yrs

 was apparently normal 1yr back 

developed nausea and vomiting  5-6ep/day,non projectile,non bilious,watery for which he had consulted a doctor at nalgonda hospital,he had given him some medications and it was relieved.

He had similar complaints later on which lasted for few days till 4months back ,came to our hospital with these complaints along with pain abdomen, investigations revealed deranged RFT and he was put on dialysis.

Last month-

pt came with 

 similar complaints of vomiting along with pedal edema and decreased urine output since 10days

*total dialysis-24

Investigations-

DAY 1-

pt came with c/o vomiting,non bilious,non projectile 5ep/day since 2days

*last dialysis was on day-1

no h/o alcohol addictions or cigarette smoking

bowel-regular

treatment history-

on insulin inj for dm-human mixtard

on tab.clonidine 100mcg and tab.nicardia 20 mg  for htn

family history-

no h/o DM-1 in his family

O/E-

pt is conscious coherent and cooperative

pallor +

vitals-

temp-98.6°F

bp-130/90mmhg

pulse-82bpm

CVS-S1S2+,no murmurs

RS-BAE+,NVBS heard

P/A-soft,non tender

CNS-

Pt is well oriented to time, place and person

cranial nerves-intact

motor and sensory System-normal

cerebellar functions-normal

investigations ordered on DAY1-

treatment given-

1.inj.PAN 80MG in 100ml NS/IV over 90mins

2.inj.METOCLOPROMIDE  10mg/IV/TID

3.T.ULTRACET 1/2 tab /QID

4.T.NICARDIA 20MG TID

5.inj.LABETOLOL 10mg in 10ml NS

6.T.MET XL 12.5MG OD

7.T.ARKAMINE 0.1MG BD

8.T.NODOSIS 500MG BD

9.T.SHELCAL 500MG OD

10.T. ALPHA D3 0.25MG OD

11.inj.HAI S/C  TID

DAY2-

c/o vomiting (not relieved)

vitals-

no fever spikes,

bp-140/100mmhg

pr-96bpm

rr-21cpm

CVS-s1s2 heard, RS-BAE+

p/a-soft,non tender

investigations ordered-

RFT-

S.ur-50,S.creat-3.6,Na-134,k-3.9,cl-90,ca-9.6 u.a-4.9

ABG-

ph-7.51,pco2-22.9,po2-11.3,HCO3-18.2

hemogram-

hb-8.1, TLC-24000,plt-2.02,pcv-23.2,rbc-2.68

NEW ORDERS-

1.salt and water restriction

2.inj.HAI 40 IU in 39 ml NS iv @5ml/hr

3.T.NICARDIA 10MG TID PO

4.T.MET XL 12.5MG OD PO

5.T.ARKAMINE 0.1mg BD PO

6.T.NODOSIS 550MG BD PO

7.inj.ZOFER 4 MG IV TID

8.T.SHELCAL OD PO

9.INJ.PIPTAZ 4.5gm iv tid

10.inj.PAN 40MG IV BD

provisional diagnosis-

CKD ON MHD WITH TYPE 1DM AND HTN