opiod abuse.pptx ok in chronic kidney disease

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1. CASE PRESENTATION GENERAL NEPHROLOGY

2. PATIENT PARTICULARS Mr. Abhijit 26 years Male Hindu Occupation: Worker R/o Irangband

3. CHIEF COMPLAINTS Altered sensorium- 10 days. Decreased urine output 10 days. Swelling of both lower limbs – 7 days. Nausea and vomiting 7 days.

4. Altered sensorium Patient was in his usual state of his health when 10 days back he started with altered sensorium after taking injection of heroin that lead to complete loss of consciousness for which patient seek care in local hospital where he was kept in icu care for 5 days after which he presented to us ,he was conscious but confused . No h/o abnormal body movements

5. Decreased urine output- 10 days Patient had decreased urine output for since last 10 days. urine output was never quantified initially, normally he used to pass 3 to 4 times per day and 1 time during night, he noticed decreased frequency of urine as he was passing 1 to 2 times per day and the quantity gradually reduced over a period of 1 week to 50 ml per day. There was h/o altered colour of urine that was reddish brown in color since last 10 days. It was not associated with frothing of urine.

6. Swelling of both lower limbs – 7 days The swelling was abrupt in onset, started from feet and ankle, and involved legs and thighs. It was associated with slight puffiness of face.

7. Nausea & vomiting 7days Patient has episodes of nausea and vomiting from last seven days, initially it was 3-4 episodes in day for first 2 days followed by 1-2 episodes, vomiting was non- projectile, greenish white in color contains most of the time food particles, associated with retching. No episode of vomiting contains blood in it.

8. No history of Fever. Burning micturition Joint pains rash Cough or symptoms of respiratory tract infection Abdominal pain Malena /hematemesis.

9. NO History of Constipation Analgesic intake –no/alternate medications Headaches, blurring of vision Yellowish discolouration of skin and eyes. No h/o diarrhoea No h/o passage of stones in urine

10. PAST HISTORY NO History of similar complaints in the past. No H/O blood transfusion and H/O tattooing in past in 2017. Received one session of HD in local hospital 7 days back K/C/O of I/V and oral drug abuser. H/O 5-6 times previous hospitalization for rehabilitation in deaddiction centres . K/C/O HEP-C since last 2 years with on and off medication intake .

11. PERSONAL HISTORY Un-married married Non vegetarian, takes mixed diet Alcoholic since 10 years 2-3 times per week 100-200ml of locally made liquor Smoker- 10 years takes 2-3 cig. per day. Normal bowel habits and bladder habits

12. SOCIOECONOMIC HISTORY He belongs to lower middle-class family. Lives in nuclear family with parents and siblings Lives in pucca house with 3 rooms with separate toilet and kitchen. Monthly family income is approx. 40000.

13. Family history There are 5 family members in total mother, father, one brother and one sister. Father was working as CRPF employee, mother is house wife, sister is doing nursing course, brother is student. No history of similar complain in any family member. H/o hypertension in mother on regular Rx.

14. DRUG HISTORY Known drug abuser (multiple drugs Tab. Sp , Tab 10, Heroin) since last 10 years He was on deaddiction therapy details not known.

15. Course in hospital Patient was admitted on 29 th may for evaluation for renal dysfunction, based on his clinical presentation he was started on I/V antibotics and received 2 sessions of HD. Patient is still oliguric. Renal biopsy is planned.

16. summary Mr. Abhijit K/C/O HCV, 26 years, Male, Hindu by religion, Worker by occupation ,R/o Irangband presented to us with altered sensorium, decreased urine output , swelling b/l/ LL and nausea and vomiting for 10 days.

17. DIAGNOSIS SYNDROMIC DIAGNOSIS: Acute glomerulonephritis PATHOLOGY MPGN(IMMUNE COMPLEX MEDIATED) ETIOLOGY– HEP C ASSOCIATED CRYOGLOBULENEMIC SLE DRUG INDUCED THROMBOTIC MICROANGIOPATHY

18. ON EXAMINATION :GPE Patient is well oriented to time place and person. Decubitus of choice Hair line normal hair texture fine Pallor- , icterus + cyanosis- Edema + Orodental hygiene satisfactory, loss of dentition No ENT discharge No lymphadenopathy All peripherial pulses are felt

19. ON EXAMINATION :GPE Bp 140/90 Pulse 88/MIN Wt 60 KG Ht 162 CM BMI 22.9kg/m2

20. RESPIRATORY SYSTEM RR 18/ MIN, THORACOABDOMINAL NO CHEST INDRAWING SHAPE Normal, bilaterally symmetrical Trachea centrally placed Chest expansion, vocal fremitus normal PERCUSSION Resonant note is heard AUSCULTATION : BREATH SOUNDS equal in both sides

21. SYSTEMIC EXAMINATION ABDOMEN Inspection- Non-Distended, umbilicus centrally placed, no visible veins and pulsations . Palpation – Temp. is normal, no tenderness, abdominal wall edema is present. No organomegaly felt. Percussion Tympanic Auscultation - BOWEL SOUNDS heard normally.

22. URINE R/E GLUCOSE nil PROTEIN 1+ PUS CELLS 1 -3 RBC PLENTY

23. DIAGNOSIS SYNDROMIC DIAGNOSIS: Acute glomerulonephritis PATHOLOGY MPGN(IMMUNE COMPLEX MEDIATED) ETIOLOGY– HEP C ASSOCIATED CRYOGLOBULENEMIC SLE DRUG INDUCED THROMBOTIC MICROANGIOPATHY