71 yr old male with h/o pyuria since 15days

A 71yr old male came to opd with chief complaint of 

White frothy urine since 15days.


History of presenting illness-

Patient was asymptomatic 15 days back ,then he developed pyuria since 15days which is insidious in onset and gradually progressive in nature and decreased output since 3days ,nocturia present 3/4 times at night. Burning micturation on 3/1/23.

History of constipation since 6 months took medication .

History of facial puffiness since 5 days and pedal edema since 15days







2yrs back had COVID symptoms and got hospitalized for 16days .

1month back had a fall while walking with Walker and had injuries on knees and ankle.


Past history:

No similar complaints in the past.

K/c/o bronchial asthma since 50yrs on inhaler.

No DM, HTN,Thyroid,epilepsy,CVD,cad


Personal history:

Wakes up at 5'0clock and reads 

10'0 clock -breakfast

2'0 clock - lunch

4'0clock - tea

9'0clock- dinner

Diet: vegetarian

Sleep:adequate and drowsy

Appetite-Decreased

Urine output -decreased

Bowel and bladder movements - decreased


Vitals on 05/01/23










Family history:

No significant family history


General examination:

Patient is conscious, not coherent ,not coperative moderately built and moderately nourished.

Vitals:

Temp : afebrile 

PR:        92/min             80.                 86

BP:.        130/80mmhg.  120/80.      120/70

Sp02:.     99%

GRBS:.    182.                 167.              117


Vitals on 6/01/23




No pallor,icterus,cyanosis, clubbing,lymphadenopathy

Bilateral pedal edema is present of pitting type.




Systemic examination:


Cvs: s1 and s2 heard ,no murmurs heard


Respiratory system: normal vesicular breath sounds heard.


Cns: no focal neurological deficit

                           R.               L

      Tone: UL.    N.               N

                LL.      N.              N


Power:

               UL:.     5/5.          5/5

               LL:.      3/5.         3/5

Reflexes:

               B.      T.         K.    A.       P

    R.       +.      ++.        -.     -.        FLEXOR

    L.      +.       ++.       -.    -.         FLEXOR

Gait: not elicited

Dysdidokinesia- absent




Abdominal examination - 


INSPECTION:


Shape – distended-uniform


Flanks – free


Umbilicus – 




Skin – normal


Dilated veins – absent


Movements of the abdominal wall - normal


Hernial Orifices, cough impulse - umbilical hernia ,present


External genitalia - normal


Renal angle - no tenderness




PALPATION:


No tenderness, temperature - normal


Liver - not palpable


Spleen - not palpable


Kidney - not palpable


Provisional Diagnosis: 

Hypervolemic hyponatremia with hypokalemia secondary to nebulization

With cystitis, with umblical hernia

With grade 1 fatty liver

With UTI , Prostatomegaly

With paraperisis under evaluation 


INVESTIGATIONS:














Treatment:


4/1/23

Inj piptaz 4.5gm iv tid

Inj.pan 40mg iv od

NS@75ml/hr

Syp potklor 15ml tid

Inj.zofer od

Protein powder with100ml milk

Syp cremaffin 10ml

Nebulizer with budecort and ipratropium


5/1/23

Inj piptaz 4.5gm iv tid

Inj.pan 40mg iv od

NS@75ml/hr

Syp potklor 15ml tid

Syp cremaffin 10ml

Nebulizer with budecort and ipratropium




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