INTERNSHIP MEDICINE POSTING

Hello everyone, I'm a medicine intern and recently started my medical posting.This is a blog to share my experience and cases I came across during this period. A 46yr old female, labourer by occupation resident of suryapet came to hospital with complaints of fever 20 days back- High grade, sudden in onset, intermittent type associated with nausea vomitings 1-2 episodes/day non projectile, bilious and food particles as contents. History of loose stools 2-3 episodes only on one day- foul smelling, no blood and mucus in stools.                 Patient was apparently asymptomatic 6yrs back. Later she developed generalised weakness and giddiness for which she was taken to hospital and diagnosed with diabetes mellitus and on glimi M1 initially and converted to glimi M2 3yrs later. History of one episode of asthma 3yrs back for which she used inhaler. Since 1yr she developed left knee pain for which she is using unknown medication regularly. 6 months back she had an episode of giddiness f

 1)Anatomical diagnosis -? Glomerulosclerosis                                                                        Etiological diagnosis -  ?? Nephrotic syndrome secondary to the diabetic nephropathy or CKD.      2)Reasons for I) Azotemia : impaired renal excretion of urea and creatinine secondary to CKD.  II) Anemia : decreased erythropoietin.  III) Hypoalbunemia: capillary basement membrane and podocytes damage.  IV)  acidosis: acidification of urine is lost.                                       3) Rationale : syp potchlor was given because of the hypokalemia.. Inj. NaHCO3 was given because of metabolic acidosis ..Insulin and antihypertensives are given because known case of DM and HTN. Orofer XT was given because of anemia.. Inj. Lasix was given to decrease her volume overload. Spironolactone was given it was a potassium sparing diuretic.Calcium was given to the patient  because of hypocalcemia secondary to CKD. Indications of NaHCO3:metabolic acidosis in cardiac arrest, Tricycli