50y male with uremic encephalopathy

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A 50 year old male came to the opd with chief complaints of 

• Decreased urine output since 15 days
• Loss of appetite since 1 week
• Shortness of breath, facial puffiness, nausea and vomiting since 15 days.

HOPI :

The patient was apparently symptomatic 2 years ago when he developed low back ache along with pain in the knee joints, elbow and wrist joints for which they went to the local hospital and took analgesics and got relieved. Patient was normal for 1-2 weeks. Then again started developing multiple joint pains along with low back ache for which he used to go to local pharmacy and took some analgesics on and off for about 2 years.

Inspite of not getting symptomatic relief, he developed decreased urine output along with vomitings which were non bilious and non projectile since 15 days for which he consulted the doctor where he was told the kidneys were affected and referred here for further evaluation on 8-06-21.

On 8-06-21 :

Urine albumin is 3+

Serum creatinine 16.6 mg/dl (.9-1.3)

Blood urea 214 mg/dl (12-42)

Hb 7.14 g/dl

On 9-06-21 :

Usg showed b/l grade 2 CKD changes.

 

He was diagnosed with 

CKD secondary to NSAID induced nephropathy.

On day 1:

Hemodialysis done.

T. Nicardia 10mg BD

T. Lasix 40mg BD

T. Orofer XT BD

INJ. Erythropoietin 4000 IU

T. Nodosis 550 ng BD

T. Shelcal 500 ng OD

On day 2:

On further questioning the patient further he complained of itching all over the body.

Added

T. Citrizine 5mg

On day 4 another dialysis was done.

On day 5,

He had 2 episodes of involuntary movements of right upper and lower limbs (clonic type) not associated with micturition or defecation associated with tongue bite.

On examination after the episode,

Pt is irritable, not oriented to time,place and person.

BP 140/80mm hg

PR 108 bpm

CNS EXAMINATION :

Tone : 

B/l - UL 2+ LL 2+

Power :

UL r 2+ l 3+

LL r 2+ l 3+

Couldn’t elicit reflexes.

Probable diagnosis : Uremic encephalopathy

Treatment :

Added :

INJ. Levipil 1g in 100ml NS IV

Levipil 500mg IV BD

On day 6,

The patient was irritable and oriented to person but not time and place.

On day 8 dialysed.

On day 9,

He was consious and oriented to place and person.

He had a fever spike on 17-06-2021 at 6:00 pm for which he was given paracetamol and it subsided.

Final diagnosis:

New onset seizure secondary to uremia (resolved).

CKD secondary to NSAID induced nephropathy asssociated with pruritis secondary to uremia.

Uremic encephalopathy.