RIGHT PROXIMAL URETERIC CALCULI WITH MILD RIGHT HYDRONEPHROSIS WITH RECCURENT HYPOGLYCEMIA 2° TO ?OHA
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CHIEF COMPLAINTS:
A 47yr old male patient came to OPD with
C/o colicky type of pain @ Right loin relays to back region
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 10-15years back then he developed pain abdomen for which he was told some swelling in the abdomen. He underwent surgery for the swelling and it was excised. 3 years back he developed pain abdomen and vomitings and was diagnosed with cholelithiasis. Cholecystectomy was done at a local hospital. Now since 8 days patient had right loin pain, sudden, colicky type associated with intermittent fever, burning micturition, decreased urine output for which he went to a local hospital he was told he has right ureteric stones. 4 days back patient visited another hospital with old reports for second opinion, then incidentally had FBS -89, PLBS - 240 then he was started on OHA's for 3 days following which he stopped OHA's as he developed Hypoglycemia.
PAST HISTORY:
Not a K/C/O DM, HTN, TB, Asthma, COPD
PERSONAL HISTORY:
Diet - Mixed
Appetite- Normal
Bowel and Bladder - Regular
Addictions - Alcohol twice a month 90ml (whiskey)
FAMILY HISTORY:
Not Significant
GENERAL EXAMINATION:
Patient is conscious, coherent, co-operative
Vitals:
BP - 110/70mmHg
PR - 82bpm
SpO2 - 98% on RA
RR - 18cpm
No Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, Edema
SYSTEMIC EXAMINATION:
CVS - S1, S2 +, No murmurs
RS - BAE + , NVBS heard
P/A - Soft, Non-tender
CNS - NAD
PROVISIONAL DIAGNOSIS:
RIGHT PROXIMAL URETERIC CALCULI WITH MILD RIGHT HYDRONEPHROSIS WITH RECCURENT HYPOGLYCEMIA 2° TO ?OHA
FEVER CHART:
INVESTIGATIONS:
HEMOGRAM:
HB - 11.3gm/dl
TLC - 35000/cumm
PLT - 1.62lakh
CUE:
SERUM CREATININE
SERUM ELECTROLYTES:
LIVER FUNCTION TESTS:
RBS:
BLOOD UREA
PLEURAL FLUID LDH:
PLEURAL FLUID SUGAR & PROTEIN:
ULTRASOUND ABDOMEN:
CLINICAL IMAGE OF ABDOMEN:
CT IMAGES
TREATMENT GIVEN UNTIL NOW:
1) IVF 25% DEXTROSE 100ml/hr slow IV over 1 hour
2) IV FLUIDS NS, RL & DNS @75ml/hr
3) INJ. OPTINEURON 1amp in 100ml NS/IV/OD
4) INJ. PAN 40mg IV/OD
5)INJ. ZOFER 4mg IV/OD
6) INJ. PIPTAZ 2.25gm IV/TID
7) FOSFOMYCIN SACHET 3gm in 100ml water OD once in 2 days for 3 doses
8) TAB. AZEE 500mg PO/OD
8) TAB. AZEE 500mg PO/OD
9) TAB. SPOROLAC 2 tabs/TID
