40 Yr old Male presenting with loin pain

 Chief Complaints:

Bilateral loin pain since 3days.

History Of Presenting Illness:

Patient was apparently asymptomatic 7days back then he sustained snake bite (with Russell viper) on left ring finger while working in the fields,visited local hospital and managed symptomatically. 

C/O bilateral loin pain,insidious in onset ,intermittent,gradually progressive,pricking type ,non radiating,aggravates on lying down.

C/O low grade fever,Nausea and vomiting,bloating.

N/C/O Burning Micturation,decreased or increased urine output.

N/C/O cough,cold,body aches,chest pain.

Past History:

N/k/c/o diabetes HTN,Epilepsy,Tuberculosis,CAD,CVA

Personal History:

Diet : Mixed 

Appetite : Normal

Sleep : Normal

Bowel and bladder moments :Regular 

Addictions: chronic alcoholic since 20years.

Tobacco smoking since 20years.

Family History:

Not significant 

General physical examination:

Patient is conscious ,coherent,cooperative and well oriented to time, place and person.

Well built and nourished.

Pallor: absent

Icterus: absent

Cyanosis: absent

Clubbing: absent

Lymphadenopathy:absent

Pedal edema:absent 

Vitals:

Temperature - 98*F

PR :- 98beats per minute 

BP :- 130/100mm Hg

RR:-18 cycles per minute

SpO2-98%











Systemic examination:

Per Abdomen:

Shape of abdomen-distended

Umbilicus -inverted

Abdomen moves accordingly with respiration.

 No sinuses/scars

Swelling in left lumber region

Abdomen is soft,tenderness in bilateral loin region.

Lipoma measuring 6x4x3cm associated with pain.

No free fluid

Hernial orifices-Normal

No organomegaly

Bowel sounds- present 

CVS examination
S1 S2 heard no murmurs
Apex beat felt the fifth fifth intercostal space medial to mid claviclar line

Respiratory system examination
Track a central
Equal bilateral chest expansion
Normal vesicular breath sounds are heard
No added sounds

CNS examination
Conscious
Cranial nerve examination, normal
No focal neurological deficits
Motor and sensory system normal

Investigations:

Liver Finction test:

Total bilirubin-0.69mg/dl

Direct bilirubin-0.16mg/dl

SGOT-18IU/L

SGPT-25IU/L

Alkaline phosphate-234

Total proteins-7.3g/dl

Hemogram:

Hemoglobin-14.8gm/dl

Total count-15000cells/m3

Platelets:2.5L

CT:2min 30sec

BT:4min 30sec

Renal function test:

Urea-68mg/dl

Creatinine-3.4mg/dl

Chloride-108

Sodium-137

Potassium-4.8

CUE:

Albumin-nil

Sugars-nil

Pus cells-2-4

Rbc- nil

Epithelial cells-2-3

Rbs-94mg/dl

USG ABDOMEN:

Right renal Cyst. 



Provisional diagnosis:

Acute kidney injury with h/o snake bite.

Treatment:

Inj Optineuron 1ampoule in 1500ml NS IV/OD

Inj Zofer 4mg IV/SOS

Inj Tramadol 100mg in 100ml NS IV/SOS

IV Fluids @NS 75ml/hr

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