A 55 year old male with weakness

 A 55 year old male came to hospital with complaints of

Weakness of all four limbs and unable to walk since 4 days

He developed weakness 2 months ago which was insidious in onset and gradual in progression after increased intake of alcohol for a few days according to the patient's attender

The weakness exacerbated 4 days ago to the point where he could not walk 

He is also not taking any food for the past 3 days

He has cough since 2 months associated with sputum. Sputum was pale coloured, no blood tinge, foul smelling, about half a cup in quantity. 

Cough increased during night for which he would wake up from the sleep.He also has SOB because of which cough

He has a history of on and off fever for 2 months which would subside on taking medication 

He has joint pains since the past 10 years for which he is taking medication. He would have episodes of fever when the joint laundry exacerbate 

Past history :

He was diagnosed with hypertension 5 years ago and using medication for the past 3 years

He was diagnosed with diabetes 3 years ago when he developed a wound over left foot

He had 2 episodes of epilepsy in the past one episode was 6years ago and was admitted to hospital for a week and the second episode was when he developed wound over his left foot and was admitted to hospital for a week

He was diagnosed with CKD 3 years ago when he developed pedal edema and decreased urine output and went for dialysis for 10 times

Treatment history :

He is using medication for diabetes since 3 years 

Using medication for hypertension since 3 years

He is using medication regularly for the treatment of gouty arthritis 

The medicines used were fabric 40 for gout

Nefrogard for CKD

Ultracet analgesic 

Personal history :

Diet is mixed 

Decreased appetite since 2 months ,he also lost weight since 1 month 

Sleep was disturbed sometimes because of cough

Bowel and bladder were normal

He used to consume alcohol every day

General examination :

Poorly built, muscle wasting present 

Pallor is present 

No signs of Icterus, cyanosis, clubbing, lymphadenopathy, edema 

Vitals :

HR 108

RR 36

Bp 130/90

Respiratory system examination :

On inspection :

Chest is scaphoid 

Trachea is central

B/L air entry present 

Decreased movement of chest on left side 

Percussion;

Hyperresonant on right side 

Decreased resonance on left side

Cardiac dullness is heard on left side

Auscultation :

Normal vesicular breath sounds heard on right side

Tubular breath sounds heard on left mammary area

CVS examination :

S1 and S2 heard

Apex beat felt in 4th intercoastal space medial to mid clavicular line

CNS examination :

Patient is conscious, coherent, non- coperative

Higher motor functions are intact