General medicine case -3

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A 60 years old woman ,daily labour by occupation come to our casuality with decreased urine output and shortness of breath  since 10 days.

History of present illness:-

-Patient was asymptomatic 7 years back .

-Patient is suffering from shortness of breath and cough for which she is using medication 

-Patient has facial swelling , shortness of breath 2 months back for which she visited government hospital .

-Patient there came to know that she has kidney problem  for that she was using medication and was refered to our hospital .

-Patient again developed shortness of breath ,pedal edema which is pitting type .

-8 days back patient admitted in our hospital  and prescribed 4 times dialysis which is twice a week.

-Past history :- 

-Patient  was diabetic from 2 months .

-No history of hypertension,asthama,epilepsy.

- Treatment history:-

-Patient undergone surgery for sterilization 25 yrs back  and has history of eye surgery .

-No allergy to known drugs .

-Personal history :- 

-Diet :- mixed 

-Appetite :- normal 

-Bowel and bladder movements :- Normal 

-Addictions :- Patient has alcohol intake and smoking habit since 30 yrs . Patient stopped alcohol intake 2 months back. 

-Family history :-

-No history of similar complaints in family members.

-General Examination:- 

-Patient is conscious ,coherent and cooperative ,well oriented to surroundings.

- Patient is moderately built and nourished .

-No clubbing,pallor,icterus,cyanosis,.                    No Lymadenopathy .

-Patient has pedal edema which is pitting type.

-Vitals:- 

-Temparature :- Afebrile 

-PR :- 90 beats /min 

-RR :- 18 cycles / min 

-BP :- 120 / 80 mm Hg 

-Systemic examination:- 

-CVS :-  Inspection :- 

Chest wall is bilaterally symetrical ,no visible pulsations, engorged veins .

Palpation :- JVP is normal .

Auscultation :- S1,S2 heard , no murmurs .

- Respiratory system:- Bilateral air entry is normal , no dyspnea .

Per abdomen :- Abdomen non tender and soft .

CNS :-  Patient is conscious ,well oriented to surroundings.

Speech is normal .

-Investigations :- 

Investigations:-

-Chronic renal failure , uremic encephalopathy.

Treatment:- 

1) Inj. Piptaz :- 2.25 g IV TID 

2)Inj.Pan :- 40mg IV OD 

3)Inj .Zofer :- 4mg IV TID 

4)Inj. Lasix :- 20mg IV BD 

5)Inj .Nodosis :- 500mg IV TID 

6) Tablet shelcal :- 500mg PO OD 

7)Tablet orofer-xt  PO OD 

 Questions :- 

1) How chronic renal failure causes uremic encephalopathy ? 

2) Is alcohol intake causes encephalopathy ?