55 year male came with loin pain ,fever and severe itching of skin.

General medicine 
Hi i am KUNAL MARATHE 3rd sem This is an online E logbook 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 a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs

Chief complaint 
A 55 yr old male patient came to opd with chief complaint of -
Loin pain since 3 month,
Severe itching of skin all over the body since 3 month and fever from 5 days.

History of present illness 
The patient was asymptomatic 3 months before then he developed loin pain radiating towards back of neck and severe itching of skin all over the body which develops into white spot.
He was having fever and shortness of breath from 5 days before coming to opd.

HO past illness 
H/O DM since 2 yrs and hypertension from 1 month.
No H/O TB,asthma , epilepsy, thyroid.

Personal history 
Married
Mixed diet
Appetite normal
Bowel movement regular
Frequently micturition 
No allergy
No alcohol and no somking 

family history 
Father is having asthama 

General examination  
Conscious and coherent
Well nourished 
No pallor 
No icterus 
No cyanosis
No lymphadenopathy
No clubbing of finger
No pedal edema.

Vitals 
Temp- 95.9 f
Bp- 130/70 mm of hg 
Pulse- 69 BPM
RR- 16cpm
SpO2- 100% at room temp
GRBS- 121gm/dl

SYSTEMIC EXAMINATION  
CVS:
Cardiac sounds: S1 and S2
No thrills
No cardiac murmurs

respiratory system:
No dyspnea
No wheeze
Central location of trachea
Vesicular breath sounds

abdomen-
Abdomen is scaphoid
No tenderness
No palpable mass
Non palpable liver and spleen
Bowel sounds are not heard

central nervous system   
Conscious 
Speech- normal
Signs of meningeal irritation - 
no neck stiffness
no kerming's sign
Cranial system - intact 
Motor system - intact 
Sensory system - intact 
 Cerebeilar signs
    Finger nose- in coordination
    Knee heel - in coordination

Provisnal diagnosis. 
Chronic renal failure
Hypertension
Diabetic mellitus

Investigation 
Hemogram , serum creatinine,
Blood urea , ultrasound, 2D echo, ECG,
Serum electrolyte.
Treatment  
Hemodialysis
Blood transfusion.

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