Iloilo Doctors Hospital Inc.

Department of Internal Medicine – Weekly Case Conference

June 14, 2022 | 8:00am | Conference Room/Zoom meeting

Case: Vomiting Urine output was adequate. Decreased

Case Presenter: Servando, Allison Eunice Mental sharpness
Moderator: Dr. Ma. Daylinda Aniceto-Chung • Advised for admission thus this case.

General Objectives
To discuss the case of a 37/M who came in due
to vomiting
Past medical History
(+) HCVD
Specific Objectives
• To discuss how to approach a patient with (+) Sore throat 2x a year
Chronic Kidney Disease and its (-) Diabetes mellitus
complications. (-) Bronchial asthma
• To discuss the Pathophysiology and the (-) FDA
Symptomatology of Chronic Kidney
Disease.
Family History
• To discuss the Differential Diagnosis of
(+) Hypertension both sides of the family
Chronic Kidney Disease
(-) Diabetes Mellitus, Bronchial Asthma
• To discuss the Treatment and
(-) Malignancies
Management of Chronic Kidney Disease
(-) Renal Disease
(+) Sore throat- nephew
General Data
• G.I
Personal History
• 37/F Patient works as an elementary teacher, non-
• Single
smoker and nonalcoholic drinker.
• Roman Catholic
Fond of eating street foods and high sodium
• Nueva Valencia, Guimaras
content snacks such as curls and pancit canton.
• Admitted last January 29, 2022

Physical Examination
Chief Complaint
Patient was seen wheel chair borne, awake,
Vomiting
conversant and not in cardiopulmonary distress

History of Present Illness Vital signs

• 5 days PTA 3 episodes of non-bilous
vomiting approximately ½ glass of
previously ingested food. No fever,
change in bowel movement, abdominal
discomfort, dizziness. (+) Insomnia. No
medications taken and no consultation
done.
• 3 days PTA. Vomiting persisted and
associated with nausea and loss of
appetite. (+) easy fatigability. No fever,
change in bowel movement, abdominal
discomfort noted. Sought consult and
laboratories were requested. Serum
creatinine 1,020
Temperature: 36.4⁰C
Pulse rate: 74 bpm
Respiratory rate: 22 cpm
Blood pressure: 140/100 mmHg
Height: 153cm
Weight: 50kgs
BMI: 21.4 kg/m2; Normal
Skin: No active skin lesions, (-) pallor, cyanosis,
clubbing, capillary refill time <2 seconds. Warm,
moist skin
HEENT: Pinkish conjunctivae, anicteric sclerae,
pupils equally reactive to light and
accommodation, non-hyperemic tonsils, neck
 Iloilo Doctors Hospital Inc.
Department of Internal Medicine – Weekly Case Conference
June 14, 2022 | 8:00am | Conference Room/Zoom meeting

vein non-distended (-) palpable neck masses,

lymph nodes,
Thorax and Lungs: Symmetrical chest
expansion, no chest wall deformity, No palpable
masses, equal tactile fremitus, no dullness,
bronchovesicular breath sounds (-) wheeze or
stridor
Heart: Adynamic precordium, PMI at 5th
intercostal space left midclavicular line, regular
rhythm, tachycardic, (-) thrills, heaves,
murmurs.
Abdomen: Flat abdomen, normoactive bowel
sound. (-) bruits. Liver span normal, Tympanitic
in all quadrants, Soft, non-tender abdomen
Musculoskeletal: no swelling, masses noted;
pink nail beds, no clubbing; good range of
motion. No peripheral edema with good
peripheral pulses
Chest Xray PA view
Neurologic Exam:
Awake, coherent, oriented to time place and Essentially negative
person, pupils equally round and reactive to cardiopulmonary findings
light, intact EOM, able to smile, raise eyebrows,
intact gag reflex, no motor deficit and sensory
ECG 12 leads
deficit
Sinus Rhythm at 81 bpm

01/29 01/30 01/31 02/01

S. Na 97 112 118 113
S. K 3.61 3.09 3.87 3.14
S. Crea 1007
BUN 20.33

01/29 02/01 02/05

Hemoglobin 97 130 135
Hematocrit 0.22 0.38 0.39
RBC 2.72 4.50 4.57
WBC 10.14 10.31 8.10
Segmenters 0.87 0.84 0.78
Lymphocyte 0.07 0.05 0.08
Monocyte 0.06 0.11 0.12
Platelet adequate Adeq. Dec.
 Iloilo Doctors Hospital Inc.
Department of Internal Medicine – Weekly Case Conference
June 14, 2022 | 8:00am | Conference Room/Zoom meeting
 Iloilo Doctors Hospital Inc.
Department of Internal Medicine – Weekly Case Conference
June 14, 2022 | 8:00am | Conference Room/Zoom meeting