General medicine

This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.  54 old man who is a dailywage labourer and construction worker  came with the c/o chest pain since 20 days.  Chest pain since 20 days which is sudden in onset, gradually progressive, diffuse, radiating to both hands Not associated with hemoptysis, cough, wheeze, dyspnea, fever, hoarsiness of voice, palpitations, easy fatigability, night sweats.  Pt was apparently asymptomatic 35 yrs back then he had cough with expectoration for 2 months which is gradual in...

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 c...