A 60 year old male with CKD, knee pain, tingling sensation in both the lower limbs and burning micturition

16/12/22 

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Sanidha Singh
206


CHIEF COMPLAINTS:
Right knee pain and swelling since 5 months 
Back ache since 5 months 
Burning micturition since 5 months
Tingling sensation in the lower limb since 4 months 



HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 10 years ago then he developed swollen ankle and feet, increased frequency of urination during night and shortness of breath and then went to near by hospital, got himself tested and was diagnosed with CKD. He is under medication (sodium bicarbonate 500 mg).

Patient developed back pain 5 months back which is squeezing type and non radiating which aggravated on lying and relieved on medication. He also developed right knee pain which is localised to the knee and also experiencing restriction of movement. No h/o trauma.

Patient also experiences burning micturition which is intermittent in nature associated with decrease frequency of urine not associated with dribbling of urine and blood in urine. Patient says that the it is relieved by consumption of toddy.

Patient is experiencing tingling sensation in both the lower limb since 4 months.








PAST HISTORY:
N/K/C/O DM, HTN, Asthma, TB, Epilepsy 
H/O CKD since 10 years
H/O of rectal surgery 15 years back (can be a rectal prolapse)



FAMILY HISTORY: 
No significant family history


PERSONAL HISTORY: 
Diet is vegetarian
Appetite is normal 
Sleep is adequate 
Bowel and bladder - decreased frequency of urine
No known allergies to pollen, dust
Occasional alcoholic 10 years back
Tobacco consumption 10 years back
Occasionally consumes toddy 


DRUG HISTORY: 
Sodium bicarbonate 500 mg 


GENERAL EXAMINATION: 

Patient is conscious, coherent and cooperative. Well oriented to time, place and person. Thin built and malnourished. 

There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy and edema.

Vitals --- 

BP: 120/80 mmHg    

PR: 81 bpm  

Temp: 97.4

RR: 17 cpm

GRBS: 20 mg%







SYSTEMIC EXAMINATION:

CVS: S1, S2 heard, no murmurs

RESP: NVBS, BAE

PER ABDOMEN: soft, non tender

CNS: NFND




INVESTIGATIONS:













TREATMENT:

1) T. NODOSIS 500 mg PO/OD
2) T. ULTRACET PO/OD 
3) T. PAN 40 mg PO/OD
4) T. MVT PO/OD















 







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