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K/c/o dm developed generalized swelling all over body,,no urine output for 3 days,cardiomegaly,pt.was refused admission

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Pt is in acute hypoglycemia either likely on insulin or high doses of sulfonilureas Present condition is critical as pt may go in coma Generalised swelling with no urine output is acute on CHRONIC DKD Raised sr creatinine over 3.02 and bul 55 Can be managed with diuretics and electrolyte balance Check for hyponatremia or hyperkalemia Beside pt has anaemia with hb6.3 and low hematocrait 21% is vitb12 deficiency likely due to metformin Thrombocytopenia needs to look for as what is reason for this As pt refuses admission which is rather urnestly needed Rx inj Ceftriaxozone Inj dexamethasone Inj lasix Inj polybion All in inj NS Monitor bsl every 2to4 hrly Suppliment inj dextrose 25% iv push urgently to correct hypoglycemia Vitals to be maintained and monitored

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Severe iron deficiency anemia Thrombocytopenia Raised creatinine and urea ? CKD ? ACUTE renal shut down due to sepsis ( ( Dengue fever ) Suggest LFT, Dengue profile , Xray chest, abdominal ultrasound, ECHO ,ABG Dialysis ( hemo / peritoneal ) Restriction of fluid to 600 ml per day . Inj Dytor IV , dopamine drip , antibiotics

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It's case to be treated as indoor. Either peritoneal or Hemodialysis. Leukocytosis should be treated with antibiotic with minimum possibility of causing renal damage. HBA1C..?. Cause of elevated createnine & Urea should be revealed. Diuretics with caution of hypokalemia ...

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A case of CKD with ANAEMIA with Thrombocytopenia urgently need of BLOOD TRANSFUSION AFTER CROSS MATCHING INJECTION LASIX 2ML IM TAB SHELCAL 500 ONE DAILY CAP AUTRIN ONE DAILY ANTIBIOTIC AND ASK FOR SALT RESTRICTED DIET,

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He is in hypoglycemia which needs immediate attention .analysis of diabetic status and revision of glycemic control

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Patient has CKD Check BP - if elevated give antihypertensive medication By Cockcroft gault formula - stage of CKD can be known - if stage 5 or ESRD then dialysis required or else medically managed Inj erythropoietin 4000iu sc weekly once given Tablet iron folic acid od Cap acebrophylline 100 bd B complex and preprobiotics given Strict glycemic control by OHA or insulin

It looks like nutritional deficiency. Macrocytic anaemia .must be having hypoproteinaemia. Has also nephropathy .Lft .urine microalbumin & egfr usg abdomen for kidney status.serum iron profile needs to be done. To be convinced for Hospitalization. Needs correction of anaemia with iron infusions .iv albumin .diuretics

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Nephrotic syndrome?? Hypoproteinemia!! Severe nutritional defeciancy? Albumin20%infusion Diaurerics with close monitoring of Potassium level Iron infusion.. If patient refuse to admit may be due to financial condition need to advice him to Go nearest Government hospital

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IT'S A..CASE OF.. DM.. WITH.. ANEMIA..THROMBOCYTOPENIA.. AND.. DIBETIC NEPHROPATHY.. NEED'S.. HOSPITALIZATION IN HIGHER CENTERS.. INVESTIGATIONS WITH EXPERTS OPINION.. MONITORING..

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