A 65 YEAR OLD FEMALE WITH PEDAL EDEMA,DECREASED URINE OUTPUT,SHORTNESS OF BREATH AND MASS PER VAGINUM
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Here is a case i have seen:
A 65YEAR OLD FEMALE WITH PEDAL EDEMA,DECREASED URINE OUTPUT ,SHORTNESS OF BREATH AND MASS PER VAGINUM
A 65YEAR OLD FEMALE,FARMER BY OCCUPATION, PRESENTED WITH C/O PEDAL EDEMA SINCE 2-3DAYS, TILL BELOW THE KNEE JOINT,PITTING TYPE,2+
SOB SINCE 3 DAYS,GRADE 4
AND DECREASED URINE OUTPUT SINCE 25DAYS
PATIENT WAS APPARENTLY ASYMPTOMATIC 20 YEARS BACK,THEN ONE DAY,WHILE SHE WAS TAKING A BATH,SHE NOTICED A MASS PER VAGINUM.
H/O CONSTPATION ON AND OFF
H/O HEAVY LIFTING (WOULD LIFT AROUND 15-20 Kg OF HARVEST,TWICE A YEAR) FOR ABOUT 35YEARS.
NO H/O DRIBBLING OF URINE,URGENCY,DIFFICULTY IN WALKING,CHRONIC COUGH.
H/O BURNING MICTURITION AND FEVER -ON AND OFF SINCE 10 YEARS FOR WHICH SHE DID NOT USE ANY MEDICATION.
H/O HTN SINCE 2 YEARS—TWO YEARS AGO PATIENT VISITED A LOCAL HOSPITAL WITH C/O BURNING SENSATION IN THE THROAT N CHEST AND DRY COUGH (ON AND OFF) ,THERE SHE WAS DIAGNOSED WITH HYPERTENSION AND WAS PRESCRIBED -NIFEDIPINE 10mg OD.PATIENT HAS NOT BEEN TAKING HER MEDICATION REGULARLY.
H/O RTA ONE YEAR AGO.SHE HAD COMPLAINTS OF CHEST PAIN,LOWER ABDOMINAL PAIN AND BACK ACHE SINCE THE ACCIDENT. SHE WAS TAKEN TO A HOSPITAL WHERE SHE WAS GIVEN MEDICATIONS FOR PAIN.
ONE MONTH AGO PATIENT PRESENTED WITH SIMILAR COMPLAINTS OF SOB,PEDAL EDEMA AND DECREASED URINE OUTPUT.
H/O DECREASED APPETITE AND SLEEP DISTURBANCES SINCE ONE MONTH.
SHE WAS ADMITTED AND DISCHARGED AFTER THE FOLLOWING TREATMENT:
1- TAB LASIX 20mg/BD
2-TAB NODOSIS 500mg/TID
3-TAB NICARDIA 10mg BD
4-TAB OROFER XT PO/OD
5-TAB SHELCAL 600mg PO/OD.
Now presented with c/o PRESENTED WITH C/O PEDAL EDEMA SINCE 2-3DAYS, TILL BELOW THE KNEE JOINT,PITTING TYPE,2+
SOB SINCE 3 DAYS,GRADE 4
AND DECREASED URINE OUTPUT SINCE 25DAYS
NOT A K/C/O DM,CAD,CVA,EPILEPSY,TB,ASTHMA.
NO H/O SMOKING AND ALCOHOL CONSUMPTION.NO KNOWN ALLERGIES.
MENSTRUAL HIST:
SHE ATTAINED MENARCHE AT THE AGE OF 13YEARS.
BLEEDS FOR 2-3 DAYS FOR EVERY 30DAYS. REGULAR CYCLES.
MENOPAUSE REACHED 20YEARS BACK.
OBSTETRIC HIST: NULLIPAROUS
GENERAL EXAMINATION:
O/E PATIENT IS CONSCIOUS,COHERENT AND COOPERATIVE
MODERATELY BUILT
PALLOR AND PEDAL EDEMA PRESENT
NO ICTERUS,CLUBBING,CYANOSIS AND LYMPHADENOPATHY.
BP: NOT RECORDABLE IN LEFT ARM
120/80 mm of Hg IN RIGHT ARM
PR: 98bpm
TEMP: AFEBRILE
RR: 24 cpm
GRBS: 156mg%
SPO2: 92% @ RA
SYSTEMIC EXAMINATION:
RS: BAE PRESENT
DYSPNOEA PRESENT
INSPIRATORY CREPITATIONS HEARD IN B/L
AXILLARY,SUPRASCAPULAR,
INFRASCAPULAR AREAS AND INTERSCAPULAR AREA.
CVS: S1S2 +
P/A: SOFT,NON TENDER
BOWEL SOUNDS PRESENT
CNS: INTACT
INVESTIGATIONS:
DONE ONE MONTH AGO-
PRESENT INVESTIGATIONS:
TREATMENT:
1-INJ.LASIX 5amp in 30ml NS
(20ml + 30ml NS)
@ 10ml/hr (40mg/hr)
2- TAB.NODOSIS 500mg PO/BD
3- TAB.SHELCAL CT PO/BD
4- TAB.PANTOP 40mg PO/OD
5- TAB.OROFER XT PO/BD
6- INJ.ERYTHROPOIETIN 4000 IU S/C,
weekly twice.
7- INJ.IRON SUCROSE 100mg in 100 ml NS/IV/weekly once
8- INJ.OPTINEURON 1amp IM/BD
9- NEBULIZATION WITH BUDECORT 8th hourly
10- SALT AND FLUID RESTRICTION
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