A 53 year old male with generalised body swelling,pain abdomen since 3days ,slurring of speech since yesterday





























Chief complaints of Generalized body swelling since 3 days

C/o pain Abdomen - 3 days

Slurring of Speech - yesterday night

Patient as apparently alright 3 days back then he had Generalised body swelling associated pitting edema


Pain Abdomen Since 3 days. not diffuse not associated with nausea and vomitings. Slurring of Speech since yesterday Night. No weakness in ULand LL but pain in both LL. Tenderness present on touch


3. HISTORY OF PAST ILLNESS

K/c/oDM-II since 3 years on insulin

K/c/o CKD since 2 years

K/c/o CAD 15 days back

Pt had anasarca 15 days back weut to hospital& diagnosed with CAD and on conservative management


Personal history 

Appetite normal 

Bowel and bladder movements regular 

No Addictions 

On examination 


  GENERAL EXAMINATION:

Patient is conscious,coherent and cooperative, moderately built and malnourished

Pallor: absent 

Icterus: absent

Cyanosis: absent

Clubbing: absent

Lymphadenopathy: absent

Pedal edema: present



VITALS:

Temperature: 98 .2F

Pulse: 116beats/minute

Blood pressure:130/70mm Hg

Respiratory rate:20cpm

SPO2 -83%at room air ,93%on 10L O2

GRBS >600 



Systemic examination 


CVS - S1 S2 heard

R/S - 

No wheeze 

Dyspnoea present 

Bilateral basal crepts present 

no palpable mass,

Trachea- central

Vesicular breath sounds heard


P/A - 

Scaphoid,Umbilicus inverted , No abdominal distention,no  visible pulsations,scars and swelling

Soft, no organo megaly

Diffuse Tenderness present 

BOWEL SOUNDS HEARD


CNS

Drowsy 

Speech slurred speech 

Reflexes could  not be elicited 


Provisional diagnosis 

Diabetic ketoacidosis?

Acute kidney injury 

Acute cholecystitis ?

Investigations 






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