23y old female with facial puffiness and pedal edema

-

  23 year old female resident of vutikodu farmer by occupation came to OPD with chief complaints :


Facial puffiness (on and off) since 5 months.


Bilateral Pedal edema (on and off) since 5 months 


Shortness of breath (grade 2) since 5 months.


Fatigue since 5 months.


 History of presenting Illness:


Patient was apparently asymptomatic 5 months ago.Then she developed facial puffiness which was insidious in onset and gradually progressive in nature ,aggrevated while working in farm and relieved on medications .




Bilateral Pedal edema since 5 months which was insidious in onset, gradually progressive in nature, aggrevated while working in farm and relieved on medications.It is pitting type.




Shortness of breath (Grade 2) according to NYHA classification since 4 months.


Sequence of events: 


Five months ago, patient developed facial puffiness, bilateral Pedal edema ,fever with chills and rigor .So she visited a near by hospital,took medication,but symptoms didn't relieve.


Later,after 3days she visited our hospital,underwent few investigations,and medications were prescribed.Symptoms relieved on using medications.


In the month of October,she got typhoid for which she took medication and later then she started developing facial puffiness and pedal edema . 


So,she came to our OPD on 22 Nov 2022 with similar complaints, prescribed medication but symptoms didn't relieve.So she came again yesterday.


Daily routine:


She is a farmer by occupation.She wakes up usually around 5:30 am ,does house hold work and breakfast by 9 am and goes to field to work .She works in farm for 3 hrs in morning,eats lunch around 1pm and takes rest.She will go home around 6pm , prepares dinner ,eat and sleep around 10 pm .


Past history:


 Not a k/c/o Diabetes Mellitus, Hypertension, Tuberculosis, Epilepsy, Thyroid disorders.


  Personal History:


  Diet:mixed 


  Appetite:decreased


  Bowel is regular


  Bladder- decreased urine output


  Sleep:adequate 


  No addictions 


  No allergies 




  Family History:


  No significant family history. 


 


  Treatment history: 




   

 On presentation her vitals:


  BP: 110/90 mm Hg 


  Respiratory Rate: 20 cpm 


  Pulse rate: 99 bpm regular,no radio radial delay 


  SpO2:98% on room air.


  GRBS: 83 mg /dL . 


   Temperature: afebrile 




   GENERAL EXAMINATION: 


   patient was consious,coherent,cooperative.


   Moderatly built and nourished.


   well oriented to time,place and person


  No pallor,icterus , clubbing, cyanosis,koilonychia , lymphadenopathy.


   B/L pedal edema - pitting type present. 

















On 30 /11/2022 


Vitals 


Temperature:Afebrile 


BP:130/80 mm of Hg 


Pulse rate: 80bpm irregular,normal value.


Respiratory Rate:18cpm 




Systemic Examination:


Cardiovascular system:


S1,S2 sounds heard.No murmurs


Respiratory system:


Bilateral air entry present


Abdomen: soft and no tenderness

Central nervous system:


No neurological deficit found.


Normal speech.




Provisional Diagnosis:


Nephrotic syndrome.


Investigation:




HEMOGRAM 






 COMPLETE URINE EXAMINATION





24 HOUR URINE (protein: creatinine) 



SERUM CREATININE




 
SERUM ELECTROLYTE





ECG

 




Treatment: 


1.Salt restriction (<2.4 gm/day)


2.Fluid restriction (<1 lit/day)


3.Tab.Lasix 20 mg PO BD 


4.Tab .Ramipril 2.5 mg PO/OD


Comments

Post a Comment

Popular posts from this blog

76 year old female with hemiballismus secondary to uncontrolled sugars

-
Image
  This is an online e log book to discuss our patient de-identified health data shared after taking his / her /  guardians signed informed consent. Here we discuss our individual patients problems through series of  inputs from available global online community of experts with an aim to solve those patients clinical  problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the  comment box is welcome. I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis"  to develop my competency in reading and comprehending clinical data including history, clinical findings  investigations and come up with diagnosis and treatment plan . Unit 1 Amc bed 1 DOA 22/5/23 A 66 yr old female ,residence of nalgonda came to the opd with c/o  Slurring of speech since 15days Involuntary movements of right upper limb since 10days And right lower li
Read more

76 Female with hemiballismus secondary to uncontrolled sugars

-
Image
 A 66 yr old female ,residence of nalgonda came to the old with c/o  Slurring of speech since 15days Involuntary movements of right upper limb since 10days And right lower limb since 5 days She was apparently asymptomatic 15days ago then she developed swelling of tongue f/b slurring of speech , insidious in onset and gradually progressive,no aggravating and relieving factors Not associated with deviation of mouth  C/o involuntary movements of right upper and lower limb,insidious in onset and gradually progressive , aggravating on increasing sugars and decreasing with decrease in grbs levels She also c/o skin lesions over genital region since 15days Past history: K/c/o HTN since 2 years K/c/o DM since one week  She has h/o joint pains( shoulder and elbow) since 2-3 months for which she went to a local hospital and the reports shower RA FACTOR+  and was advised tab . methotrexate (on regular medication) Personal history: Diet :mixed  Appetite:normal  Bowel and bladder:regular but c/o bu
Read more
-
Chief complints- A 4yrs old female child Was brought by mother with the complaints of cough :: 7days History of Presenting illness: child was apparently asymptomatic 7days back then developed cough which was Productive type, diurnal variation Present, gradually progressive more during the night time associated with post tussive vomiting. It is associated with nasal discharge noisy breathing, not associated with mouth breathing H/o fever  5 days back for 3 days which was gradual in onset, low grade, intermitta not associated with rigors; aggrevates durine night time , relieved on taking medication Past History  H/o nasal discharge at 3 months of age. Shown to local RMP , where symptomatic and supportive treatment was given and symptoms subsided. No documentation available Antenatal History -conceived spontaneously after 9 months of married life Natal History Full term, LSCS  BT WT 2.5kg cried immediately after birth Breast fed within 24 hours of delivery . POST NATAL HISTORY H/O NiCU
Read more