A 42 year male patient came with complaints of fever, decreased appetite, fatigue and weakness

General medicine 
Hi i am Ishan More 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

Cheif complaints :
A 42yr old male patient came to OPD with chief complaints of-
High grade fever , decreased appetite, fatigue, weakness 1 week back.

History of present illness:
The patient was asymptomatic one week before then he developed high grade fever, decreased appetite, fatigue and weakness .

History of past illness:
No history of any past illness
No H/O TB, asthama, epilepsy, diabetes, Hypertension

Personal history:
Married
Mixed diet
Appetite normal
Bowel movement regular
Frequently micturition 
No allergy
5 years ago occassionally alcohol intake but stopped from 5 years 

family history 
No family history 

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

Vitals 
Temp- 98.6 f
Bp- 120/80 mm of hg 
Pulse- 82 BPM
RR- 16cpm
SpO2- 98% at room temp
GRBS- 102gm/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

Investigation 
Hemogram , serum creatinine,
Blood urea , ultrasound, 2D echo, ECG,
Serum electrolyte, complete urine examination.
Treatment:
Hemodialysis

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