1701006138 CASE PRESENTATION

 LONG CASE:

A 22 yr old female,who is a farmer by occupation, studied upto 10th standard,came to the opd with the chief complaints of 

*Generalised swelling of the body since 5 days 

*No urine output since 5 days 

#HISTORY OF PRESENT ILLNESS;

She was apparently asymptomatic 5 days back then she noticed swelling of the body , initially involving the face and periorbital region ,later legs from ankle to thighs and also upperlimb and abdomen.

Swelling was insidious in onset, gradually progressive and associated with pain .no aggravating and relieving factors.

No urine output since 5 days , initially there is decreased urine output for 2 days followed by no URINE OUTPUT.

H/o loss of appetite since 10 days 

H/o blurring of vision,for which she has been provided spectacles.(15 day ago)

No h/o burning micturition and dysuria 

No h/o fever ,rash and abdominal pain 

No h/o nausea , vomiting, headache.

No h/o chronic cough, hemoptysis and weight loss.

No h/o bone pain 

No h/o pins and needles sensation in foot 

#PAST HISTORY;

SHE is k/c/o Diabetes since 12 YEARS on regular medication (isophane insulin)

K/c/o Hypertension since 1 year on medication (tab .Telma 40 mg and tab .nicardia 20 mg)

No h/o TB, asthma,CAD, EPILEPSY, thyroid disorder.

#FAMILY HISTORY;

NO h/o Hypertension, diabetes in the family members.

#PERSONAL HISTORY;

DIET;mixed diet 

Appetite; decreased

Bowel and bladder; bowel is regular but bladder -no urine output since 5 days 

Sleep - adequate

*GENERAL EXAMINATION:

after taking consent from patient,she is examined in a well lit room and after adequate exposure,

She is conscious, coherent, cooperative

She is moderately built and poorly nourished.

She is oriented to time ,place and person

On examination she has pallor.

No  icterus,clubbing, cyanosis, lymphadenopathy

There is oedema (pitting TYPE)

*VITALS;

•TEMPERATURE: febrile @time of examination

•PULSE:100 BPM

•RR:20 CPM

•BP :140/90 mm of hg , measured in supine position and in left upper arm.

•Spo2-97%

•Grbs-220 mg/dl 

SYSTEMIC EXAMINATION;

*PER ABDOMEN;

#INSPECTION;

Shape of ABDOMEN- round and distended with flank fullness 

No visible scars and sinuses

No visible engorged veins

Umbilicus is inverted and central in position.

#PALPATION;

SOFT and non tender

No organomegaly.

*Fluid thrill is present.

#Percussion;

Dull note heard over the abdomen 

#AUSCULTATION;

Bowel  sounds are heard normally

No bruit heard

*RESPIRATORY SYSTEM;

ON inspection,shape of chest is B/l symmetrical

Movements of chest -equal on both sides

Trachea appears to be in central position

On PALPATION,there is decreased movement of chest over both lower lobes ( infra axillary and infra scapular)

Vocal fremitus -decreased in IAA,ISA on both sides 

ON Percussion thers is Stony dull ness over IAA,ISA on both sides.

On AUSCULTATION; absent breath sounds over ISA,IAA .

NVBS heard above the dullness.

Vocal resonance is also decreased over both lower lobes.

*CVS;

S1,S2 heard ,no murmurs,jvp is normal.

*CNS;  intact

Higher mental functions are normal

No meaningeal signs

Motor and sensory systems are normal

Gait is normal.

*PROVISIONAL DIAGNOSIS;

#NEHPROTIC SYNDROME with out any complications 

#DIABETIC NEPHROPATHY with bilateral PLEURAL EFFUSION.

INVESTIGATIONS;ON 10/6/22

#CBP:

•Hb;6.5gm/dl

•RBC count:2.42millions /cumm

•TC:7100cells/cumm

Neutrophils;70%

lymphocytes;17%

MCV:80.2fl

MCH:26.9pg

MCHC;33.5%

RDW-cv;14.2%

Platelet count:1.20lakhs/cumm 

•Smear:normocytic and normochromic

#CUE:

Color -pale yellow

Appearance-clear

Reaction -acidic

•ALBUMIN-3+

•PUS CELLS :4-5

•RBC: absent

•Casts : absent 

#BLOOD UREA:110mg/dl

#SREUM CREATININE:6.2mg/dl

#SREUM electrolytes;

Na :136mEq/l

K:3.5mEq/l

Cl:97mEq/l

#SEROLOGY;

*HbsAg; negative 

*AntiHCV antibodies;non reactive 

*HIV 1/2 rapid test ;non reactive 

#USG : FINDINGS 

*B/l grade 2 RPD 

*Gross ASCITES

*B/L MODERATE to gross PLEURAL EFFUSION.

#CHEST XRAY; 

#ECG;

#2DECHO; 

#Investigations on 11/6/22.

Hemogram:

•Hb-6.2g%

•Blood urea-127 mg/dl

•Serum creatinine -6.7mg/dl

 #Treatment;on 10/6/22

-Inj.lasix 60mg/iv/BD

-Inj .human actrapid insulin.6U/iv/stat

-Insulin infusion 6ml/hr 

-Tab.nicradia 20 mg /po/BD

-Tab .Telma 40 mg/po/OD

-NBM till further orders 

-Fluid and salt restriction

-Grbs monitoring hrly .

#Treatment on 11/6/22:

-Inj. lasix 60 mg /iv/BD 

-Inj insulin infusion 6ml/hr 

-Tab.nicardia 20 mg/po/bd

-Tab. Telma 40 mg/po/oD 

-NBM till further orders

-Fluid and salt restriction.

-Grbs monitoring hlry 

#Investigations on 12/6/22

•Blood UREA:68mg/dl 

•SERUM CREATININE: 4.5mg/dl 

#Treatment on 12/06/22:

-Inj.lasix 60 mg/iv/BD

-Inj .human actrapid S/c 

-Tab.nicardia 20 mg /PO/BD

-Tab.Telma 40 mg/PO/oD 

-Fluid and salt restriction

-Bp/PR/Grbs 4th hourly 

--------------------------------------------------------------------------------------------------------------

SHORT CASE:

A 12 year old boy ,who is a 7th standard student, resident of miryalaguda ,stays in the hostel ,he is taken to the hospital by his father with chief complaints of 

# itching all over  body but more in the web spaces of fingers of hands since 10days .

#HOPI:

he was apparently asymptomatic 10  days ago ,then he noticed  itching involving all over the body . itching is insidious in onset , gradually progressive and  more during night time.

No h/o fever, vomiting and diarrhea

No h/o cough and cold

#PAST HISTORY;

No similar complaints in the past

No h/ o asthma, TB, epilepsy 

No h/o drug intake

#FAMILY HISTORY:

No similar complaints in the family 

But his roomate is having similar complaints in the hostel.

#PERSONAL HISTORY;

Diet ;mixed 

Appetite;normal

Bowel and bladder: regular 

Sleep : disturbed due to itching since 4 days

No known drug allergies

#GENERAL EXAMINATION;

He is examined in a well lit room and after adequate exposure.

He is conscious, coherent, cooperative and well oriented to time ,place and person.

He is moderately built and moderately nourished.

#VITALS :

Temperature: Afebrile

Pulse rate; 95bpm

RR; 18 CPM

BP:110/80mmhg ,measured in sitting position in left upper arm

#SYSTEMIC EXAMINATION;

*RS: BAE - present,no added sounds

*CVS;S1,S2 heard,no murmurs 

*PER ABDOMEN:soft and non tender,No organomegaly.

*CNS: Intact

#CUTANEOUS EXAMINATION;

ON Examination,there are papules and excoriated lesions over finger web spaces and periumbilical region.

#PROVISIONAL DIAGNOSIS;

*SCABIES.

#Investigations;

Hemogram;

•Hb-12g%

•Tc-normal

•Platelets -normal

KOH mount;

*Shows eggs and adult mites.

#Treatment;

*Tab.levocet-for 15 days OD at night time

*Permethrin 5%lotion ,apply all over the body below neck before going to bed and keep it  for atleast 12 hours and repeat it after one week. 

#Advice;

*All family members are given the same treatment.

*All used clothing and bedsheets should be kept aside for 10 days, washed and dried under sunlight .