A 39 year old male with abdominal pain

39yrs od male came with the cheif  complaints of pain abdomen since 4 days andcomplaints of increased frequency of urination with burning micturition since 4 days,fever since 4 days.

[  ] HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 3 yrs back then he went to a hospital with complaints of increased frequency of urination and diagnosed to be as Type2 diabetes mellitusand startedhis medication taking  oral antidiabetic drugs,he was on regular followup.Since 1 month he is on routine checkup. He had uncontrolled sugars >300.Now presented with complaints of pain abdomen at umbilicus and at lower abdomen region since 4 days

C/O  b/l loin pain since 4 days,intermittent not associated with nausea ,vomiting,abdominal distension,loose stools.Burning micturition since 4 days with red colored urine.

C/O increased frequency of urination/urgency.Sometimes he is passing urine in his clothes before reaching the washroom (Urge incontinence)

Fever since 4 days,low grade,intermittent, not associated with cough,cold associated with chills and not associated with rigors .

No Shortness of breath

No palpitations

No pedal edema

PAST HISTORY: known case of DM 3years back.
Not a known case of  HTN ,ASTHMA,TB,EPILEPSY.

PERSONAL HISTORY:

Diet :mixed
Appetite:normal
Bowel :Regular
Bladder :increased frequency. 
Addictions:consumes alcohol occasionally. 

FAMILY HISTORY:
No significant family history.

[  ] GENERAL EXAMINATION:

No pallor , icterus , cyanosis , clubbing, lymphadenopathy , edema.
VITALS
Temp : 103*F

Pulse : 86bpm

RS : 20cpm

BP : 160/100mmhg

Spo2 : 98% at RA

GRBS : 274mg/dl

SYSTEMIC EXAMINATION:

CVS : S1,S2 heard

RS : BAE present.NVBS+

P/A : Tenderness present at lower abdominal region,B/L loin tenderness present

CNS : No focal neurological deficet


[  ] INVESTIGATIONS:







ECG:


USG ABDOMEN:

REVIEW OF USG:

2D ECHO:


PROVISIONAL DIAGNOSIS:

??ACUTE PYEONEPHRITIS 

TREATMENT:
1.inj meropenem 1gm/iv/bd

2.Tab.PAN 40MG OD

3.inj neomol 1gm/iv/tid

4.Tab.AMLONG 5mg PO OD

6.INJ.HUMAN INSULIN nph 8----8,regular 8---8---8

8.GRBS MONITORING

9.INJ.FALCIGO 120MG IV 8am today.

10.BP/PR/TEMP MONITORING


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