Diabetic Nephropathy

This is an a 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 problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

The patient/ attender was informed the purpose of the information being acquired. An informed consent was taken from patient/ attender and there is omission of information that was requested to be omitted. 
A 60 year old female patient agricultural worker by occupation,resident of kodad came to general medicine department with C/o Tingling and numbness of both lower limbs from ankle to calf muscles since 1 year
       
HOPI
patient was apparently asymptomatic 10 months back,then she had tingling sensation and numbness of lower limbs from ankle to calf muscles which was insidious in onset,gradually progressive and lost sensation of foot. 
She was taken to khammam private hospital with similar complaints,taken medication but not relieved
C/o Shortness of breath while walking few steps and stops for some time to take breath with no aggravating and relieving factors
Nocturia present
Polyphagia present
Polyuria absent
No c/o chest pain, palpitations, orthpnea and paroxysmal noturnal dysuria
No c/o burning micturition
No c/o fever,cough and cold

Past history
K/c/o diabetes since 30 years
K/c/o bronchial asthma since 30 years
K/c/o hypertension since 1 month
K/c/o CKD since 1 month
N/K/c/o epilepsy,TB

TREATMENT HISTORY
Drug history
Tab.Metformin 500mg three times a day for diabetes since 30 years
Levosalbutamol for bronchial asthma since 30 years and budesonide since 1 month
Tab.losartan for hypertension since 1 month
Past surgical history
Tubectomised 30 years back
Hysterectomy 20 years back

PERSONAL HISTORY
Patient takes mixed diet
Appetite decreased
Regular bowel and bladder movements
Sleep disturbed due to tingling and burning sensation of feet
Addictions - toddy drinker

FAMILY HISTORY
no significant family history 
ALLERGIC HISTORY
no allergies to any kind of drugs or food items
GENERAL EXAMINATION
Patient is conscious, coherent, and cooperative 
Moderately built and nourished
Pallor present
No icterus 
No cyanosis 
No clubbing
No lymphadenopathybuilt and nourished
Pallor present





VITALS:

Temperature - Afebrile
Pulse Rate - 88 bpm
Respiratory Rate - 16cpm
Blood Pressure - 110/70mmHg
Sp02 - 99% at Room air
GRBS - 344 mg/dl

SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM
S1 ,S2 heard,no murmurs,no thrills

RESPIRATORY SYSTEM
INSPECTION
Bilateral Air entry Present
Trachea- central 
Movements of Chest decreased on left side
Type of respiration- thoracoabdominal

PALPATION
All inspectory findings confirmed by Palpation 
Expansion of chest normal
Tactile vocal fremitus

                          Right Left
Supra clavicular normal normal
Infra clavicular normal normal
Mammary normal normal   
Inframammary normal normal 
Axillary: normal normal
Infra axillary normal normal
Supra scapular normal normal
Infra scapular normal normal  
Inter scapular normal normal

PERCUSSION:
 
                          RIGHT LEFT         
Supra clavicular: resonant resonant
Infra clavicular: resonant resonant 
Mammary: resonant resonant 
Inframammary resonant resonant 
Axillary: resonant resonant 
Infra axillary: resonant. resonant
Supra scapular: resonant resonant 
Infra scapular: resonant dullnote
Inter scapular: resonant. resonant 

AUSCULTATION
Vocal resonance normal on both sides
Normal vesicular breath sounds heard

PER ABDOMEN EXAMINATION:
INSPECTION 
Abdomen Shape Obese
Umbilicus is central in position
PALPATION 
No Tenderness on palpation.
Temperature - Afebrile
Liver is Non palpable
Spleen is Non palpable
PERCUSSION: tympanic note 
AUSCULTATION Bowel Sounds Heard

CENTRAL NERVOUS SYSTEM 
Patient is conscious coherent and cooperative
Speech is normal 
No signs of meningeal irritation
Cranial nerves - intact 
Sensory system normal 
Motor system:
Tone - normal 
Power - bilaterally 5/5 
Deep tendon reflexes 
Biceps : ++
Triceps : +
Supinator: +
Knee : ++
Ankle : +
Superficial reflexes - normal 
Gait - normal  
INVESTIGATIONS
PROVISIONAL DIAGNOSIS
DIABETES NEPHROPATHY WITH KNOWN CASE OF DIABETES,BRONCHIAL ASTHMA , HYPERTENSION AND CKD

TREATMENT
14/10/23
Nebulisation Duolin 6th hourly
                   Budesonide 12th hourly
Tab Losartan 50 mg po/oD
Tab metformin 500mg PO/BD
GRBS PROFILE
 
15/10/23
Inj.human actrapid insulin s/c TID before meals
Nebulisation Duolin 6th hourly
                   Budesonide 12th hourly
Tab Losartan 50 mg po/oD
Tab metformin 500mg PO/BD
GRBS PROFILE

16/10/23
Inj.human actrapid insulin s/c TID before meals
Inj.Lasix 40 mg PO/OD
Tab.Nodosis 500mg PO/OD
Tab.Shelcal PO/OD
Nebulisation Duolin 6th hourly
                   Budesonide 12th hourly
Tab Losartan 50 mg po/oD
Tab metformin 500mg PO/BD
GRBS 2nd hourly monitoring 


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