Uremic encephalopathy with type 1 respiratory failure

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This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome."


" I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan "


C/o shortness of breath since 3 days

C/o decreased urine output since 1 day

C/o altered sensorium

HopI 

Pt was apparently asymptomatic asymptomatic until 3 days ago and then had c/o breathlessness  insidious onset gradually progressive in nature orthnopena pnd 

No c/o pedal edema chest pain palpitations

No c/o fever cough cold vomiting loose stools 

K/c/o HTN since 2 yrs 

K/c/o ckd since 2 yrs 

Not a k/c/o Dm thyroid cad cva 

Prev history of enucleation surgery 

Consumption of alcohol beedi occasionaly 

General examination:


Pt is conscious coherent cooperative well oriented with time place and person 
No signs of clubbing, cyanosis, pallor ,icterus,lymphendenopathy 

Vitals:

Bp:110/70

Pr:82bpm 

Rr :26cpm 

Temp :97.3



Systemic examination:

Cvs s1 s2 heard 

Rs:  nvbs heard 

Cns: no focal neurological deficits 

Per abdomen: bowel sounds


Provisional diagnosis:

Uremic encephalopathy 

Severe metabolic acidosis (hagma)

Type 1 respiratory failure with anemia 


Treatment:

Ryle feeds 

INJ mi dazolam 30 mg 

INJ fentanyl 200 ml 

16 ml ns @4ml /hr 

INJ norad /amp 

INJ dobutamine 1amp 

Patient was shifted to dialysis unit for dialysis from icu 

Central line is placed 

Acvm mode fio2 100 %

Patient is on mechanical ventilation breathing with 97% spo2






Investigations 







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