A 57 year old male farmer by occupation came to the OPD with cheif complaints of pain in the joints , swelling and weakness.

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A 57 year old male farmer by occupation came to the OPD with chief complaints of pain in the joints , swelling and weakness since 3 days.

HISTORY OF PRESENTING ILLNESS.

Patient was apparently asymptomatic 15 days back then he noticed swelling in the both the lower limbs, pain in the joint and weakness since then. Later he visited the hospital and was on medication that caused resolution of symptoms , but patient complained of polyuria . So he stopped the medication nearly on the 11th day . After that he again developed similar symptoms before 3 days and pain got increased which was pricking type and also involved right upper limb.

There was history of fever before 3 days.

There is history of polyuria not burning type and no history of hematuria.

There is no history of headache , nausea , vomiting.

There is no history of cough, difficulty in breathing and shortness of breath.

There is no history of trauma.

PAST HISTORY

There are no similar complaints in the past.

Patient is not a known case of hypertension, diabetes , T.B , asthma , epilepsy, CAD.

There is no surgical history.

DRUG  HISTORY

There are no known allergies for drugs or food particles.

FAMILY HISTORY 

There is no significant family history.

PERSONAL HISTORY

DIET :- mixed

APPETITE :- decreased 

SLEEP :-  decreased 

BOWEL movements :- regular 

BLADDER movements :- increased

ADDICTIONS :- takes 90ml of alcohol daily  since 6 years.

GENERAL. EXAMINATION

Patient is examined in a well light room after taking the consent.

Patient is conscious, coherent and cooperative, moderately built and moderately nourished.

There are no signs of pallor , icterus , cyanosis , clubbing , koilonychia , lymphadenopathy.

Pedal edema present (non-pitting type).

VITALS

Temperature :-afebrile 

Pulse rate:- 96bpm

Resp rate :- 20 cpm

B.P:- 120/80 mm of hg.

SYSTEMIC EXAMINATION 

CVS :- S1, S2 heard, no murmers heard.

Respiratory system :- trachea is central, normal vesicular breath sounds heard.

Per abdomen :- soft , non tender, no organomegaly elicited. Shape of abdomen scaphoid.

CNS :- cranial nerves are intact.

No signs of meningeal irritation.

Speech is normal.

GCS (E4V5M6)

REFLEXES

                    R              L

Biceps        ++             ++

Triceps       ++            ++

Supinator    ++            ++

Knee            ++           ++

Ankle           ++            ++

INVESTIGATIONS 

Hemogram , Complete urine examination  , RFT  , LFT

ECG

2d echo

Urinary electrolytes 

Blood and urine culture.

PROVISIONAL DIAGNOSIS 

Polyarthralgia with hypotonic hyponatremia.

TREATMENT 

Monocef INJ.  i.v, bd.

Aldactone tab. (50mg) po, od.

Thiamine INJ.(200mg in 100 ml of n.s ) i.v , bd.

Pan INJ. (40mg)  i.v , od.

Neomol INJ.  i.v , s.o.s.

Vitals monitoring regularly(for every 4hrs.)

GRBS (6th hourly).

Vitcofol INJ. i.m , od.

Dolo tab. (650mg) po, tid.

Input/output charting.