54 yr old male with dyselectrolytemia

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CASE PRESENTATION:

A 54year old male ,came  with complaints of Hiccups since 4 days 

Decreased Apetite since 4 days

Generalised weakness since 4 days

HOPI:

Pt was apparently asymptomatic 7 years back and then had history of trauma to foot which was not healing went to hospital and was diagnosed as having diabetes initially on OHA and later changed to insulin (MIXTARD)

Patient has similar complaints 8 months ago and 4 months ago and 1 month ago developed similar complaints of hiccups and was in altered sensorium and was diagnosed as altered sensorium secondary to dyselectrolytemia and CKD(Diabetic nephropathy)

He was diagnosed with HTN(Denovo HTN 1mnth back and started on.Tab Cinod 10mg Po od

And 1 month ago his electrolytes on 27-10-2022 sodium 130mEq/L

Potassium 2.6mEq/L

Chloride 92mEq/L

And sodium and potassium correction were given at that admission 

Vitals at present admission 

Bp:120/70mmHg

PR:80bpm

On Examination :

Patient is c/c/c

Pallor -Absent

Icterus -Absent

Cyanosis -Absent

Clubbing -Absent

Lymphadenopathy -Absent

Edema -Absent

CVS-S1S2 +

RS-BAE +

CNS -His higher mental functions are intact and he is oriented to time,place and person 

Investigations

His electrolytes on 25/11/22

Sodium 120mEq/L

Potassium 2.5mEq/L

Chloride 94mEq/L

Serum osmolarity 228mOsm/L

His electrolytes on 26/11/22

Sodium 123mEq/L

Potassium  2.7mEq/L

Chloride 88mEq/L

FBS:116mg/dL

Urinary electrolytes 

U sodium 85

U potassium 10.2

U chloride 139

His electrolytes on 27/11/22

Sodium 122mEq/L

Potassium 8.8 mEq/L

Chloride 150 mEq/L

His electrolytes on 28/11/22

Sodium 125 mEq/L

Potassium 2.9 mEq/L

Chloride 90 mEq/L

Diagnosis:

DYSELECTROLYTEMIA 

WITH CKD (Diabetic nephopathy)

Treatment:

1) 0.9% NS@ 100 ML/HR 

2)INJ.KCL 1 AMP.  IN 500 ML NS IV OVER 5 HOURS

3)TAB.BACLOFEN 10 MG PO/TID

4)TAB.CINOD 10 MG PO/OD

5)INJ.PANTOP 40 MG IV/OD

6)INJ.HAI S/C TID ACC TO GRBS