46 year old patient with emphysematous pyelonephritis

 

Short case:FINAL MBBS PRATICAL EXAMINATION:

June 10' 2022

A 46yr old male patient with emphysematous pyelonephritis

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Name: K. Thanmai

Roll no :65

Batch : 2017

Hall ticket : 1701006087

CASE PRESENTATION :

A 46 year old male came with chief complaints of:

Burning micturition present since 10 days

Vomiting since 2 days  ( 3 - 4 episode)

Giddiness and deviation of mouth since 1 day 

HISTORY OF PRESENTING ILLNESS:   

Patient was apparently asymptomatic 10years back, 

he complained of polyuria for which he was diagnosed

 with Type 2 diabetes mellitus he was started on OHAs.

3years back OHAs were converted to insulin.

2 days back, he developed vomiting , containing food

 particles and  non bilious. He also complained of 

deviation of mouth and giddiness 1 day

His  GRBS  was also recorded high , for which he was 

given NPH 10 IU and HAI 10 IU

No history  of fever/cough/cold

No history of previous UTIs

No history of  chest pains/palpitations/syncopal attacks

PAST HISTORY:    

    

10yrs back patient was diagnosed with Type 2 DM.

3 years back , he underwent cataract surgery.

1 year back, he had h/o small injury on leg which

 gradually progressed to non healing ulcer extending

 upto below knee eventually ended with below knee 

amputation  due to development of wet gangrene.

Not a k/c/o HTN/Epilepsy/TB/BA/Thyroid disorder/CAD/CVD

PERSONAL HISTORY:

Diet - Mixed

Appetite- normal

Sleep- Adequate 

Bowel and bladder- Regular

Micturition- burning micturition present

Habits/Addiction:

Alcohol- 

Not consuming alcohol since 1 yr.

Previously (1yr back) Consumption of 

alcohol, about 90mlwhiskey  almost daily.

Also 1month on&off  consumption pattern was 

 previously present.

FAMILY HISTORY:

Not significant

GENERAL EXAMINATION:

Vitals @ Admission:

BP: 110/80 mmHg

HR: 98 bpm

RR: 18 cpm

TEMP: 101F

SpO2: 98% on RA

GRBS: 124 mg/dL

Pallor present

No Icterus/Cyanosis/Clubbing/Koilonychia/Lymphadenopathy/Edema

No dehydration

Systemic Examination:

CVS: S1S2 heard, No murmurs

RS: BAE+,NVBS

P/A: Soft, Non tender

CNS: 

Reflexes: (Biceps/Triceps/Knee/Ankle/Plantar)Normal

Power: Normal(5/5) in both Upper and Lower limbs

Tone: Normal in both Upper and Lower limbs

No meningeal signs

Investigations:

URINE  FOR KETONE BODIES 

X RAY  KUB

LFT 

RFT

Ultrasound abdomen and pelvis:

BACTERIAL CULTURE REPORT:

Culture report: Klebsiella pneumoniae positive:

CT SCAN:

Sodium- 130

Chloride- 97

Hb- 6.4

TLC- 13,700

Platelet count- 50000

Urea - 146 

Creatinine- 4.2

Uric acid- 9.1

X ray KUB 

                                                                 Dj stenting        

PROVISIONAL DIAGNOSIS:

Right emphysematous pyelonephiritis 

and left acute pyelonephiritis and encephalopathy 

secondary to sepsis.

H/o of Type 2 Diabetes mellitus since 10years

 

TREATMENT:

INJ. MEROPENEM 500mg IV BD 

INJ. ZOFER 4mg IV TID

INJ. RANTAC 50mg IV OD

INJ. LASIX 40 mg IV BD

IV Fluids- NS,RL @ 100 mL/hr

SYP. MUCAINE GEL 10 mL PO TID

INJ.HAI SC TID ACC to GRBS

TAB.DOLO 650 mg SOS