57 years old ckd with meningitis

57 years old Male pt who works as labour , resident of miryalaguda .. presented with the chief complaints of FEVER since 1 week  and NECK STIFFNESS   and altered sensorium  ... 

History of present illness  : 
      a. The patient was apparently asymptomatic  2 yr back  and noticed swelling in the legs 1 and half year ago  
     b. Then they visited a hospital  in miryalaguda  .. where they diagnosed the patient as chronic kidney disease patient  
     c. The hospital adviced for the patient to start dialysis  
     d. The patient started the dialysis and  he did well for 5 to 6 months  
     e. The due to pandemic  and financial problems .. he stopped the dialysis  for 8 months 
     F.  8 months back.. he absorbed swelling of his legs and decreased in the urine out put 
         He also had motions and vomitings
    g . Then he admitted in the hospital  and started dialysis again .. and continued.. twice weekly  
    H.  1 week back ... he came to the hospital with complaint of fever and neck Stiffness  
       Fever  was high grade  associated with chills and rigor  , not associated with loss of consciousness  
  

Past history  : 
  There was a history of DIABETIC MELLITUS  and HYPERTENSION  since 4 years  
   There is no known history of TB , asthma,  epilepsy 
There is  no known history of surgeries and accidents 
   Month ago there was a 2 session of blood transfusion  

Personal history  :
        He was married  
       Diet : mixed .. but consuming only veg after ckd diagnosis since 2 years 
       Appetite  : decreased  
    Bowel and bladder : regular  
       Addictions : alcoholic   ... but stopped since 2 years 
    No known  Allergies 
    Decreased miturition  


Family history: 
   There is no known case of DM , HTN , genetic abnormality 

general examination  : 
     The patient is in altered sensorium 
 On examination  patients mood appears to be dull 
      No   pallor, icterus, cynosis clubbing , lymphadenopathy,  edema  are observed 
     Vitals  : 
   TEMP : 98.6
BP : 120/ 80 mmhg
PR : 92/ min
RR : 20/ min 
Spo2 : 98% on RA
    
   Systemic examination  : 

CVS : S1, S2 + 
RS : BAE + , NVBS 
P/A : SOFT , NON TENDER 
CNS : 
PATIENT IS altered sensorium not orinted with time place person
SPEECH : SLURRED 
SENSORY SYSTEM : INTACT 

MOTOR SYSTEM :  
                               R                         L 
TONE      UL    Increased.            -
                  LL      Hypotonic          -
       
POWER     UL       1/5                  3/5 
                   LL       1/5                  3/5
  
REFLEXES
 
         B      T      S      K        A         P

R      1+     1+     -       -          -         Flexor

L       1+    1+   1+     -          -         Flexor,

Gcs: E4V1M4
 Meningeal signs: 
       Neck stiffness: positive  
       Kernings sign : positive  
       Brudzinski sign : positive 


Purpura can be seen

 
Diagnosis: 
       
chronic kidney disease on maintaining hemodilysis  With k/c/o  diabetic mellitus  , HTN 
With pyogenic bacterial meningitis ? 

Investigations : 

A. Ecg reports on 27/11/21 
    

B. Ecg report  on  24 /11/ 21 
    

C. Reports on 24 / 11 / 21 
 

Phosphorus  is 3.8 mg/DL  Normal 
D. Reports on 25/11/21 and 26/11/21 

E. CFS analysis 
 

Fever chart 

On 2/12/21



 Treatment  :
TREATMENT GIVEN :
HEMODIALYSIS on 25/10/21,28/10/21,2/11/21,6/11/21,  21/11/21(WITH PRBC),  24/11/21( with PRBC),25/11/21 ( WITH PRBC)

Inj DEXAMETHASONE 8 MG IV/BD
RT FEEDS -100ML MILK@4TH HOURLY 
              - 100 ML WATER @ 4TH HOURLY
INJ PAN 40 MG IV OD 
TAB NODOSIS 500 MG /RT/BD 
TAB SHELCAL CT RT/OD
TAB OROFER XT RT/BD 
INJ ERYTHROPOIETIN 4000 IU /SC/WEEKLY ONCE 
INJ FALCIGO 120 MG IV (0,12,24,48 HRS )
INJ MEROPENAM 500 mg IV/BD
FLUID RESTRICTION < 1 L / DAY 
SALT RESTRICTION <2 gm /day 
INJ HAI S/C ( INFORM GRBS TO PG)




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