70yr/Male c/o increased BP, decreased Urine output and B/L limbs involuntary movements

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A 70year old male patient came to the OPD with the cheif complaint of increase in blood pressure, decrease in urine output since 15days, involuntary movements of B/L limbs since 12pm on 20/11/2022.

• cheif complaint:-  increase in blood pressure, decrease in urine output since 15days, involuntary movements of B/L limbs since 12pm on 20/11/2022.

 • History of present illness:-

patient was apparently asymptomatic 12 days back then he noticed decreased urine output, and involuntary movements of b/l limbs since 1day.

 • History of past illness:-

k/c/o of CKD,since 20 years (regular medication)

N/k/c/o HTN,DB,TB, Epilepsy,CAD.

NSAID abuse( +)-(used NSAID'S for back pain from 2009)

 • Personal history:-

Martial status:- Married

Occupation:- Farmer

Appetite -Normal

Non-vegetarian

Bowels-Regular

Micturition -Normal

No known allergies

 • Habits/Addictions

              Alcohol-Regular

              Tobacco -No

               betel nut- No

               betel leaf-No

               drug use-No

 • Family History:

No history of DM, CAD, Asthma and thyroid disorders in the family

 • General Examination:

Vitals:

Temp:99.2°F

Respiratory rate:18/min 

Pulse:108/mim

Blood pressure:150/100mmhg

Sp O2 :97%

GRBS:-138mg%

 • Systemic Examination:

Cardiovascular Examination:

Thrills:no

Cardiac sounds:S1,S2 heard

Cardiac murmurs:no

 • Respiratory system:

Dysponea:no

Wheeze:no

Position of trachea: central

Breath sounds: vesicular

Adventitious sounds:

 • Abdomen

Shape of abdomen: Scaphoid

Tenderness:no

Palpable mass:no

Henias orifices: normal

Free fluid:yes

Bruits:no

Liver:Not palpable

Spleen:not palpable

Bowel sounds:yes

 • Central Nervous system:

 Pt is conscious

Speech: normal

Signs of meningitis:no

Cranial nerves:normal

Motor and sensory system:normal

Central Nervous system:

 • Diagnosis:-

  CKD on MHD

Lichen simplex chronicos(legs)

Pytriasis versicolor(upper back)

 Investigations:

Treatment: