Case history- 1

August 10, 2021

" This is an online E log book to discuss our patient's  de- identified health data shared afterctaking 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 baeed inputs. .This e- log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome"

Date of admission: 04-08-2021

A 45 year old female  patient presented to OPD with chief complaint of snake bite 7 days back.

HISTORY OF PRESENT ILLNESS:

Patient was apparently well one week back and on wednesday patient was bitten by snake (Russel's viper) on right foot and she was taken to local hospital for treatment within 1 hr and anti snake venom was  administered.

She was fine for one day. Then she complains of swelling on right lower limb and taken to local hospital for which  ointment was advised.

Gradually, the swelling subsided. After 3 days, patient presents with 2- 3  bilious vomiting with severe abdominal pain. 

Abdominal pain is squeezing type in preumbilical region.

There is no history of necrotic tissue changes around the bite.

 No history photophobia, phonophobia, lacrimation and diplopia.

No history of chest pain, palpitation and syncopal attack.

No history of shortness of breath, orthopnea and  PND

No history of  burning micturition

No history of pedal edema and facial paralysis.

PAST HISTORY:

Not a known case of hypertension, CAD, asthma, TB, epilepsy, thyroid disorders.

No history of surgeries and blood transfusion in the past.

FAMILY HISTORY:

There is no history of similar complaints in the past. There is no history of  sudden death in the family.

PERSONAL HISTORY:

Diet: mixed

Appetite: normal

Sleep: adequate 

Bowel and bladder movements: irreular  (constipation)

Micturation: normal

Addictions: no

TREATMENT HISTORY:

Patient had not undergone any treatment prior. She is not allergic to any known drugs.

GENERAL EXAMINATION:

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

There is no signs of  pallor, icterus, cyanosis, clubbing and generalized lymphadenopathy. 

There is no pedal and bipedal edema.

VITALS:

Temperature: 98°F

Blood pressure: 150/ 90 mm Hg

Respiratory rate: 24 cpm

Spo2: 99% at room temperature

GRBS: 180 mg %

SYSTEMIC EXAMINATION 

CARDIOVASCULAR SYSTEM:

 

Chest wall is bilaterally symmetrical.

No visible pulsation , engorged veins , scars and sinuses

AUSCULTATION: S1 and S2 sounds are heard

RESPIRATORY  SYSTEM:

Position of trachea- central

Bilateral air entry- positive

Normal vesicular breath  sounds heard

No wheezing  sounds

PER ABDOMEN:

 

Abdomen is distended, soft and non tender.

Bowel sounds heard

No palpable mass or free fluid

CENTRAL NERVOUS SYSTEM:

Patient is conscious

Speech- Normal

No signs of meningeal irritation 

Motor and sensory system - normal

Reflexes - present

Cranial nerves- intact

INVESTIGATIONS:

APTT

Prothrombin time

HBsAg- RAPID

RFT

Complrte blood picture

PROVISIONAL DIAGNOSIS:

This is a  case of acute kidney  injury secondary to acute tubular necrosis secondary to snake bite with  thrombocytopenia.

TREATMENT:

 1.  Foley's  catherization for output monitoring

2. Oral fluids  3 litres/ day

3. Injection lasix 40mg/ BD

4. Strict I/0 monitoring 

5. Inj PAN iv/ OD

6. Inj  Zoffer 4mg/ iv

7. Inj  Buscopan IM/BD

TECHNIQUES FOR REMOVAL OF VENOM FROM THE BODY:

1. First aid

2. Administration of anti snake venom

3. Mechanical ventilation 

 

  Questions:

 1. Why did this case of snake bite only affected  kidneys ?