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
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
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