Gen Med

  65 YEAR OLD MALE WITH ANASARCA   65 year old male came to the casuality on at 3:30pm on 8/11/21 with c/o b/l pedal edema since 10 days  c/o shortness of breath since 4   days c/o facial puffiness since 2 days   c/o decreased appetite since 2 days c/o decreased urine output  Patient was  apparently asymptomatic 3 years ago, then he developed Rt sided hemiparesis and was diagnosed with CVA and was on antiplatelets on and off. He was also diagnosed with DM at that time and HTN one year later  Patient has c/o pedal edema ( upto knee, decreasing on rest ) and shortness of breath ( grade II-III ) since 1 1/2 year and was diagnosed with chronic kidney disease 1 1/2 years ago and is on regular medication. No dialysis was done. Managed conservatively. C/o pedal edema since 10 days gradually progressed toward face  (Pitting type) C/o shortness of breath (grade II-III) since 4 days  Facial puffiness since 2 days  A/w loss of appetite and decreased urine output  Not a/w orthopnea, PND  The patie

 32 M , autodriver pt presented to casuality with SOB grade 2-3 since 2 days , vomitings since 2 days Pt was apparently asymptotic 6 years back  Pt c/o polyuria , polyphagia and went to KIMS for evaluation and diagnosed with DM type 1 and started on insulin mixed 25U—-X—25U and shifted to insulin 20U—-X——20U since 4 years  HOPI - since 2 days pt c/o vomiting 3-4 episodes / day , associated with food particles not associated with bile , blood , associated with abdominal pain , squeezing type   Relived after vomiting ,associated with SOB grade 2-3 , no organomegaly , no PND  No c/o loose stools , constipation, burning micturation  No c/o chest pain , palpitations , syncopal attacks  No c/o abdominal distension , pedal edema  H/o Dm 1, since 7 years  No H/o HTN, CUA, CAD , TB , Asthama , epilepsy  No H/o abdominal pain  No similar complaints initially at the time of presentation  O/E : pt is c/c/c  Temp: 99.8 F  Pulse : 102 bpm Bp- 140/80mmhg  Spo2: 98% GRBS: 480mg% Ketones : POSITIVE    

 52 /M , saree weaver by occupation presented with h/o slurring of speech ,deviation of mouth -that lasted for 1 day and resolved on same day . Brain imagining was done which showed cerebellar infarct and denovo HTN + patient was asked to continue medication regularly but he didn’t  He is chronic smoker 1 pack of beedi/day and chronic alcoholic since 30 years consumes 90 -180 of Ib thrice weekly  Pt gives h/o - giddiness -5 days back at 7 am in the morning pt was on routine works and suddenly at 7am .pt felt giddiness and took rest .it was associated with 1 episode of vomiting  on the same day pt had h/o  postural instability , while walking to and was about fall no seizure like activity Pt was assyptomatic for 3 days then he consumed small amount of alcohol  Pt was assymptomatic till 3pm then the patient developed -giddiness , sudden onset and gradually progressive , continuous and increased on getting up from bed , while walking , associated with B/L hearing loss , aural fullness , t