General medicine case 3
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Date of admission : 10th September 2021
A 14 year old male came with the complaint of
- involuntary movements since one day
- vomitings since one day
History of present illness :
- The patient was apparently asymptomatic 20 days back then he noticed facial swelling and pedal edema which was treated by local doctor.
- After few days the patient developed fever for which he was given symptomatic treatment and the condition subsided.
- He had 4 episodes of vomiting on 9th september with increased blood pressure and involuntary movements.
- The patient also noticed reddish urine output
History of past illness :
- The patient is not a known case of hypertension, diabetes, tuberculosis, epilepsy, asthma.
Personal history :
- The patient has no loss of appetite
- He takes mixed diet
- He has proper bowel and bladder movements
- No sleep disturbances
- No addictions
Family history :
- There are no similar complaints in the family members
Treatment history :
- The patient has taken medications for fever and pedal edema associated with facial puffiness
- He is not a known case of drug allergy.
General examination :
- Patient is conscious, coherent, cooperative at the time of joining
- No pallor
- No icterus
- No cyanosis
- No clubbing of fingers and toes
- No lymphadenopathy
- No pedal edema
Vitals : temperature - afebrile
Pulse rate - 78 bpm
Respiratory rate - 18 cycles per minute
BP - 130/90 mm Hg
Systemic examination :
CVS
Inspection - chest wall is bilaterally symmetrical
- No precordial bulge
- No visible pulsations, engorged veins, scars, sinuses
Palpation - JVP is normal
Auscultation - S1 and S2 heard
RESPIRATORY SYSTEM
- Position of trachea is central
- Bilateral air entry us normal
- Normal vesicular breath sounds heard
- No added sounds
PER ABDOMEN
- abdomen is not tender
- bowel sounds heard
- no palpable mass or free fluid
CNS
- Patient is conscious
- Speech is present
- Reflexes are normal
Provisional diagnosis : Acute glomerulonephritis
Investigations :
Hemogram :
Complete urine examination :
ECG :
TPR chart :
Urine microscopy :
Serology : Negative
ESR : 25 mm Hg
Renal function tests :
Urea : 40
Creatinine : 1.0
Calcium : 8.8
Phosphate : 3.6
Sodium : 139
Pottasium : 4.3
Chlorine : 102
Liver function tests :
AST - 22
ALT - 19
Final diagnosis : Acute glomerulonephritis
Treatment :
Inj. Zofer 4 mg IV
Tab. PCM 650 mg
Inj. Optineuron 10 mp in 100 ml NS IV
Tab. Sodium valproate 500 mg OD
Inj. Pantop 40 mg IV
Fluid restriction < 1.5 litre/day
Salt restriction < 4 g/day
1. What are the causes of acute glomerulonephritis?
2. Differential diagnosis for acute glomerulonephritis ?
3. Why did the patient have involuntary movements ?
4. When can the condition be diagnosed as secondary to streptococcal infection?
5. What are the features of nephritic disease?
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