Lasya Sakilam 117

A 56 Yr old male R/o Miryalaguda,  dialy labourer by occupation came to hospital on 19 November 2021 for his dialysis  Hopi :  Patient was apparently asymptomatic 2 years back when he was diagnosed with CKD when he had c/o bilateral pedal edema  Patient has come to the hospital for his regular dialysis session on 19 Nov, after running regular tests he was told he requires blood transfusion.  Dialysis session was delayed due to blood transfusion ( the last dialysis session was 14 days back).  Patient developed fever since 3 days associated with chills and rigors and increased during night. No associated vomiting, diarrhea, shortness of breath.  Patient's relative noticed slurring of speech and not responding to commands since 1 day  Past history :  H/o hypertension and diabetes mellitus since 4 years.  Diagnosed with CKD 2 years back, for which he is on dialysis twice a week  H/o blood transfusions 2 times in the past, recent one is 2 months back. And one more  blood transfusion on

65 year old male with anasarca    A 65 Yr old male resident of narketpally, vro by occupation came to hospital on 8 November with C/O : B/l pedal edema since 2 weeks Shortness of breath since 2 weeks Hopi : Patient was apparently asymptomatic 3 yrs back then he developed hemiparesis on right side and he was put on antiplatelet Then he was diagnosed with diabetes and hypertension  He also had complains of b/l pedal edema after which they diagnosed him with CKD Now,  2 weeks back he started developing edema which is insidious onset, gradually progressive, associated with pain.  It started on legs, then progressed to hands abdomen and face in that order.  Edema aggravated on walking and not relieved on medication.  It is associated with shortness of breath which is grade 4 on NYHA classification  Associated with decreased urine output  No associated fever, chest pain, cold  Past history :  H/o diabetes mellitus since 3 years  H/o HTN since 1 1 /2  years  H/o kidney disease since 3 years 

A 61 Yr old male, farmer by occupation, resident of Suryapet came to OPD on 2 nd Nov 2021 C/O : 1) swelling on both legs since 20 days           2) shortness of breath since 5 days HOPI : Patient was apparently asymptomatic 20 days back, then he developed Pedal edema : insidious in onset, gradually progressed from just above the ankle to knee level. Right side more compared to left. No aggravating factor, not relieved on medication. Not associated with fever. Associated with shortness of breath which is grade 4 acc to NYHA , orthopnea present, no PND. Patient has reduced urine output since 4 months. Past history : K/C/O hypertension since 15 years  Diagnosed with CKD 4 years back Went to NIMS with c/o anorexia, dyspepsia, reduced sleep and Sr. Creatinine was found to be 2 mg/dl. Put on dialysis after that.  No history of diabetes, asthma, TB, heart disease.  No H/O any surgeries  Treatment history : Patient was on medication for CKD for 2 1/2 years after diagnosis He is on dialysis

       Alcohol withdrawal seizures Age             : 42 yrs Gender      : male Doa.            : 26 October 2021  C/o : patient was brought to icu after an episode of seizures Hopi :  patient was not consuming alcohol 10 yrs back. Then he started drinking alcohol with his friends occasionally 90-180 ml whisky 2-3 times in a week to relieve his pain after work  He increased alcohol consumption after the death of his wife 10 yrs back gradually to about 12 units / day  He started chewing tobacco 10 yrs back ( 1 pack / day).  He was on and off frequently on counselling. He stops consuming alcohol after counselling for 10 days and then goes back to consuming alcohol for about a month.  He has started experiencing tremors for 2-3 days  whenever he stops consuming alcohol since 8 yrs.  On 12 October he was admitted to psychiatry after the relatives noticed binging of alcohol. He was on medication fora week. Then after 2 days  of stoppage of medicine he experienced seizures.  Past history :