CASE HISTORY
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A 15 years old male patient studying 9th class came to casuality with complaints of shortness of breath since 4 hours associated with acute chest pain since 4 hours.
History of present illness:
Patient was apparently asymptomatic 1 month back , patient complains of vomitings 2 to 3 episodes daily associated with food particles and not associated with blood.
Patient gives history of fever 1 month back associated with chills which is relieved by using medication for 2 days.
Incidentally he diagnosed raised urea 63 mg / dl and raised creatinine 8.3 mg/dl went to Hyderabad with in one day urea has raised to 135 mg/dl and creatinine 10 mg /dl and started him on dialysis .
5 sessions of hemodialysis done and USG -ABD showing bilateral kidney size of 8.1 cm and loss of CMD increased echotexture grade 3 RPD changes. Since then he was on hemodialysis.
Patient complains of SOB aggrevating on supine position .
Patient complains of chest pain dragging type
Patient no complaints of palpitations , syncopal attack , decreased urine output , pedal edema ,facial puffiness.
Past history :
Patient has no history of Diabetes mellitus, hypertension , tuberculosis, epilepsy ,Asthma.
Family history: no similar complaints in the family
Drug history : patient has undergone 3 cell packs of blood
Personal history:
Diet : mixed
Sleep: adequate
Appetite: normal
Bowel and bladder movements : regular
Habits : no addictions
General examination :
Pallor
No cyanosis
No clubbing
No icterus
No lymphadenopathy
Pedal edema
Vitals :
Temperature : 98.6 F
Pulse rate : 96/min
Respiration rate : 24 cps
Bp 140/100
Spo2 : 86%
GRBS : 121 mg %
Systemic examination:
Cardiovascular system:
S1 and S2 heard
No thrills
No murmers
Respiration system:
Patient suffers with dysopnea
No wheezing
Position of trachea central
Abdomen :
Shape of abdomen :scaphoid
No tenderness
No palpable masss
Hernial orifice normal
Spleen and liver no palpable mass
Central nervous system:
Patient is conscious, coherent.
Speech is normal
provisionalDiagnosis:Acute kidney injury
Investigations:
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