A 65 YEAR OLD FEMALE WITH PEDAL EDEMA,DECREASED URINE OUTPUT,SHORTNESS OF BREATH AND MASS PER VAGINUM

 This is an online E log book 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 series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

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: 





Day 5:





THROMBOSED VESSEL

PROVISIONAL DIAG:CHRONIC RENAL FAILURE WITH THIRD DEGREE UV PROLAPSE

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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