A 60 year old male patient with ? UTI,CHRONIC CYSTITIS,? AKI ON CKD,Hypokalemia secondary to ? insulin use.

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   A 60 year old male patient came to casualty with c/o high grade fever since 5 days,

Dry cough since 6 days,
SOB on exertion since 4 days.
C/o constipation since 4 days.
C/o burning micturation since 10 days.
No c/o decreased urine output.


HOPI: Patient was apparently asymptomatic 10 days back, then he had burning micturation,and high grade fever a/w nausea and dry cough, not a/w chills and rigor,he had constipation since 5 days.
 
PAST HISTORY: Patient is a k/c/o DM since 30 yrsand was on medication DAPAGLIFLOZIN 10 MG OD and TAB. VOGLIBOSE 0.3 MG OD and  on insulin since 2 days MIXTARD as his Sr.Creatinine is 2 mg/dl
K/C/O HTN since 30 years on TAB. AMLONG 2.5 MG OD .


PERSONAL HISTORY

DIET- MIXED
APPETITE- Normal
SLEEP- Adequate
B&B- Decreased
ADDICTIONS- Consumes alcohol occasionally.

GENERAL EXAMINATION:
patient is concious/coherent/cooperative, moderately built and nourished.

No pallor
No icterus
No clubbing
No edema
No lymphadenopathy.

Vitals: Temp- 101 F
            PR- 80 BPM
            RR- 19 CPM
            BP- 120/70 mm Hg
            SpO2- 98%@ RA
            GRBS- 387 mg/dl

Systemic examination:
CVS: S1 S2 + ,NO MURMURS
RS: BAE+, NVBS
CNS: INTACT
P/A: SOFT, DISTENDED, GUARDING + ,BS SLUGGISH.

INVESTIGATIONS























PLAN OF TREATMENT :
KCl one ampoule in 10 ml NS over 4 hrs.
Inj.MONOCEF 1gm IV BD
Inj PANTOP 40 mg IV OD
Inj.ZOFER 4 mg IV SOS
Inj.NEOMOL 1 gm IV SOS
Tab.DOLO 650 mg PO TID
Tab.AMLONG 2.5 mg PO OD
Inj.HUMAN ACTRAPID SC Acc to GRBS
Syp.LACTULOSE 10 ml PO BD
Syp.GRILLINCTUS 10 ml PO BD 


                                   DAY 1:

S- 


O- Temp- 101 F
            PR- 80 BPM
            RR- 19 CPM
            BP- 120/70 mm Hg
            SpO2- 98%@ RA
            GRBS- 387 mg/dl

A- UTI?
   CHRONIC CYTITIS
    GRADE 2 BPH 
    ?AKI ON CKD [DIABETIC NEPHROPATHY]

P-1] KCl one ampoule in 10 ml NS over 4 hrs.
2]Inj.MONOCEF 1gm IV BD
3]Inj PANTOP 40 mg IV OD
4]Inj.ZOFER 4 mg IV SOS
5]Inj.NEOMOL 1 gm IV SOS
6]Tab.DOLO 650 mg PO TID
7]Tab.AMLONG 2.5 mg PO OD
8]Inj.HUMAN ACTRAPID SC Acc to GRBS
9]Syp.LACTULOSE 10 ml PO BD
10] Syp.GRILLINCTUS 10 ml PO BD 



                                 DAY 2 :

S- 



O-Temp- 101 F
            PR- 86 BPM
            RR- 19 CPM
            BP- 110/70 mm Hg
            SpO2- 98%@ RA
            GRBS- 387 mg/dl 

A- ?UTI 
    CHRONIC CYSTITIS
    ?AKI ON CKD 
     DM + 
     HTN +  

P- 
1]IVF NS RL @ URINE OUTPUT + 30 ML/HR
2]Inj.MONOCEF 1gm IV BD
3]Inj PANTOP 40 mg IV OD
4]Inj.ZOFER 4 mg IV SOS
5]Inj.NEOMOL 1 gm IV SOS
6]Tab.DOLO 650 mg PO TID
7]Tab.AMLONG 2.5 mg PO OD
8]Inj.HUMAN ACTRAPID SC Acc to GRBS
9]Syp.LACTULOSE 10 ml PO BD
10] Syp.GRILLINCTUS 10 ml PO BD 


                              DAY 3 :

S- 

O-Temp- 101 F
            PR- 96 BPM
            RR- 19 CPM
            BP- 90/60 mm Hg
            SpO2- 98%@ RA
            GRBS- 387 mg/dl 

A- ?UTI 
    CHRONIC CYSTITIS
    ?AKI ON CKD 
     DM + 
     HTN +  


P- 
1]IVF NS RL @ URINE OUTPUT + 30 ML/HR
2]Inj.MONOCEF 1gm IV BD
3]Inj PANTOP 40 mg IV OD
4]Inj.ZOFER 4 mg IV SOS
5]Inj.NEOMOL 1 gm IV SOS
6]Tab.DOLO 650 mg PO TID
7]Tab.AMLONG 2.5 mg PO OD
8]Inj.HUMAN ACTRAPID SC Acc to GRBS
9]Syp.LACTULOSE 10 ml PO BD
10] Syp.GRILLINCTUS 10 ml PO BD 


            DAY 4 :

S- 

O-Temp- 101 F
            PR- 90 BPM
            RR- 19 CPM
            BP- 100/70 mm Hg
            SpO2- 98%@ RA
            GRBS- 387 mg/dl 

A- ?UTI 
    CHRONIC CYSTITIS
    ?AKI ON CKD 
     DM + 
     HTN +  


P- 
1]IVF NS RL @ URINE OUTPUT + 30 ML/HR
2]Inj.MONOCEF 1gm IV BD
3]Inj PANTOP 40 mg IV OD
4]Inj.ZOFER 4 mg IV SOS
5]Inj.NEOMOL 1 gm IV SOS
6]Tab.DOLO 650 mg PO TID
7]Tab.AMLONG 2.5 mg PO OD
8]Inj.HUMAN ACTRAPID SC Acc to GRBS
9]Syp.LACTULOSE 10 ml PO BD
10] Syp.GRILLINCTUS 10 ml PO BD 
11]TAB . NODOSIS PO/TID 
12]CAP BIO D3  PO/OD 
13]INJ LASIX 40 MG  IV/BD


             DAY 5 :







S- NO FEVER SPIKES , BURNING MICTURATION + , COUGH +


O-Temp- 101 F
            PR- 90 BPM
            RR- 19 CPM
            BP- 120/70 mm Hg
            SpO2- 98%@ RA
            GRBS- 387 mg/dl 

A- ?UTI 
    CHRONIC CYSTITIS
    ?AKI ON CKD 
     DM + 
     HTN +  

1]IVF NS RL @ URINE OUTPUT + 30 ML/HR
2]Inj.MONOCEF 1gm IV BD
3]Inj PANTOP 40 mg IV OD
4]Inj.ZOFER 4 mg IV SOS
5]Inj.NEOMOL 1 gm IV SOS
6]Tab.DOLO 650 mg PO TID
7]Tab.AMLONG 2.5 mg PO OD
8]Inj.HUMAN ACTRAPID SC Acc to GRBS
9]Syp.LACTULOSE 10 ml PO BD
10] Syp.GRILLINCTUS 10 ml PO BD 
11]TAB . NODOSIS PO/TID 
12]CAP BIO D3  PO/OD 
13]INJ LASIX 40 MG  IV/BD





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