1601006100 case presentation

 LONG CASE 

A 40/F Came with complaints of  

1)Facial puffiness since 1 year 

2)Itching all over the body since 1 year  and developed multiple plaques on abdomen and Lower limbs.                                                            

 3)abdominal distention since 1 month.

4)Sob  since 1 month.

5)pedal edema since 1month .

H/O PRESENT ILLNESS

Patient was apparently asymptomatic 3year back then she developed bilateral knee

 pains gradual in onset, progressive  aggrevating on sitting & squatting,relieved on

 rest ,for which she visited near by RMP doctor and on medication (steriods) since

 then. 1yr back she developed facial puffiness ,itching and rashes all over the

 body and abdominal distension . since 1month she is having  pedal edema pitting

 type (grade3) involving bilateral lower limbs below the knees and shortness of

 breath since 1month insidious onset and gradually progressive aggrevating on

 exertion grade 2 not associated with chest pain ,sweating and palpitation . Decrease

 of urination since 10days not associated with burning micturing .

Itching scaly lesions all over the body.

Abdominal distention:

             

  PAST HISTORY:

she developed b/L knee pain 3 years ago and is under medication( demisone 0.5 mg and acelogic SR). 

Not a K/C/O DM/HTN/ asthma / Ischemic heart disease .

No h/o of trauma

                Fever 

                Loss of weight

                Loss of appetite.

FAMILY HISTORY 

NO SIGNIFICANT FAMILY HISTORY

PERSONAL HISTORY:

OCCUPATION -Daily wage worker

DIET -MIXED

APPETITE -decreased 

SLEEP -NORMAL

BOWEL AND BLADDER HABITS : decreased urine output 

ADDICTIONS: NO

GENERAL EXAMINATION :

Patient is concious coherent and coperative

VITALS :

BP -110/80

PR -90bpm

TEMP 98.5degrees F

SPO2 98 @ RA

GRBS -106

NO -PALLOR, ICTERUS , CYANOSIS, CLUBBING , LYMPHADENOPATHY 

*edema on both lower limbs-pitting type.

SYSTEMIC EXAMINATION:

CVS-S1 S2

P/A-SOFT, NON TENDER, NO ORGANOMEGALY 

RS - BAE  

plaques on lower limbs:

1

              

       INVESTIGATIONS:      

Lipid profile: total cholesterol:248mg/dl

                      Triglycerides:347mg/dl

                       HDL:49mg/dl

                       LDL:92mg/dl

                       VLDL:69.4mg/dl

PROVISIONAL DIAGNOSIS:

? It might be iatrogenic Cushing's syndrome associated with tinea corporis.

TREATMENT:

 Tab:ATARAX 25mg for itching

 Ointment luliconazole cream for ringworm infection.

Injection;LASIX 40mg/IV/BD

Tab:ALDACTONE 25mg/PO/BD

Injection:PANTOP 40mg/IV/OD

Injection:OPTINEURON 1amp in 100ml in normal saline /IV/OD

Tab:ULTRACET/PO/BD

Knee caps 

Strict I/O charting

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SHORT CASE 

 A 30 year old female came to hospital with

CHEF COMPLAINTS OF:

Facial puffiness ,pedal edema since months.

&Sob since 2days.

HISTORY OF PRESENT ILLNESS:

Patient was asymptomatic months back then she

developed facial puffiness and bilateral leg swelling

pitting type

PAST HISTORY:

Known clinical history of -chronic renal failure &

hypertension.

TREATMENT HISTORY:

Using antihypertensive medications since 4yrs.

FAMILY HISTORY: mother also have hypertension.

PERSONAL HISTORY:

-Married, house wife

Appetite-normal ,sleep: inadequate

Diet: veg

Bowel and bladder: normal

Known allergies:no

GENERAL EXAMINATION:

Patient is conscious, coherent, cooperative.

-pallor on hands

No icterus

No clubbing, cyanosis

Edema of both legs.

VITALS:

Temp-98.3c/f

BP-110/80mm/hg

PR-92bpm

SP02-98%

GRBS-104mg%

CVS:

-SIS2 HEARD

RESPIRATORY SYSTEM:

-BAE

PROVISIONAL DIAGNOSIS:

CHRONIC KIDNEY DISEASE

Plan of care: hemodialysis

INVESTIGATIONS:

TREATMENT:

Inj-epo 4000i.v s/c weekly

Tab:Lasix 40mg po/BD

Tab:nicardia 20mg po/tid

Tab:orofer po/bd

Tab:nodosis 500mg po/tid

Tab:PANTOP 40mg po/od

Tab:shelcal po/op

Tab :arkamine 0.1mg po/bd