A 50 YEAR OLD MALE WITH LOSS OF APPETITE

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Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


Chief complaints:

A 50 year old male patient, construction worker by occupation came with complaints of

 Loss of appetite since 25 days


History of presenting illness-

Patient was apparently asymptomatic 2 years back, then he went to the hospital with complaints of loss of appetite and was diagnosed to have renal failure and hypertension.

Patient had dialysis beginning from 2019 till 2020 outside hospital 

Then in 2021 he came to our hospital and had 2-3 dialysis after which dialysis was stopped and he was on conservative management and had regular follow ups.

He came with complaints of loss of appetite since 25 days and pain in bilateral loin region since 25 days 

No history of decreased urine output, pedal edema, shortness of breath, chest pain, palpitations, cough.

History of usage of NSAIDs (3-4/day) for bilateral knee joint pains, pricking type which was aggravated on exertion and relieved on taking medication.

Past history

Hypertensive since 2 years and on medication. No history of diabetes, tuberculosis, asthma, epilepsy.

Treatment history

Tab. Amlong 2.5mg 

Tab. Arkamine 100mg


Personal history-

 He takes mixed diet, loss of appetite, bowel and bladder movements are regular.Non alcoholic non smoker

On general physical examination:


Vitals:

BP-140/90 mm hg

PR- 86 bpm

Temp- afebrile

RR- 20 cpm

Spo2- 98% on room air

Pallor- present

No signs of icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.



Systemic examination:

CVS: S1 S2 +, no murmurs

RS: BAE+, NVBS, no added sounds

CNS: NAD

P/A: distended, soft, non tender, BS+






Investigations:














Provisional Diagnosis:
CHRONIC KIDNEY DISEASE SECONDARY TO NSAID ABUSE?



Treatment:
1.Fluid restriction <1.5 l/ day
2. Salt restriction <2-4 g/ day
3. TAB. LASIX 40 MG PO BD
4. TAB NODOSIS 500MG PO BD
5. TAB SHELCAL CT PO OD
6. TAB. OROFER XT PO OD
7. INJ SODIUM BICARBONATE 100 MEQ

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