Medicine case

  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 discussion 65yr old male pt who was a farmer by occupation brought to casuality with c/o 2 episodes of seizures 3hrs back. Pt was apparently asymptomatic 6yrs back then he had a h/o trauma for which he went to a local hospital and CT brain was done which came out to be normal. At that hospital he was diagnosed to be hypertensive and was put on amlodipine but patient was not on regular medication. Then 1yr back he started having symptoms such as forgetfulne

  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 discussion A 55yr old female patient came to opd with complaints of abdominal pain,loose stools and vomitings since 10days. Pain abdomen diffuse in nature,non radiating Vomitings 3 episodes per day ,non projectile, contains food particles,immediately after eating,non bilious and not blood tinged. Loose stools 3-4 episodes per day ,small in volume, watery in consistency not associated with blood Patient was apparently asymptomatic 10years back then she developed

 1)Anatomical diagnosis -? Glomerulosclerosis                                                                        Etiological diagnosis -  ?? Nephrotic syndrome secondary to the diabetic nephropathy or CKD.      2)Reasons for I) Azotemia : impaired renal excretion of urea and creatinine secondary to CKD.  II) Anemia : decreased erythropoietin.  III) Hypoalbunemia: capillary basement membrane and podocytes damage.  IV)  acidosis: acidification of urine is lost.                                       3) Rationale : syp potchlor was given because of the hypokalemia.. Inj. NaHCO3 was given because of metabolic acidosis ..Insulin and antihypertensives are given because known case of DM and HTN. Orofer XT was given because of anemia.. Inj. Lasix was given to decrease her volume overload. Spironolactone was given it was a potassium sparing diuretic.Calcium was given to the patient  because of hypocalcemia secondary to CKD. Indications of NaHCO3:metabolic acidosis in cardiac arrest, Tricycli