50 yr old female with generalised edema

 NOTE: THIS IS AN ONLINE E LOGBOOK 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 A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.  

This is case of 50 yr old female came with c/o:

Generalised edema since 15days

Decreased urine output since15days

HOPI:  H/O consumption of 90ml of alcohol for every 10 days since 4yrs

pt was apparently asymptomatic 4months ago then she had hip fracture due to skid  since then she is bed ridden

Then she developed edema after 3and half months of hip fracture, insidious in onset gradually progessive, first it developed at abdomen then it progressed to foot,decreased urine output since 15days

No h/o burning micturition,no h/o sob, palpitations,no h/o vomitings,

PAST HISTORY:

Patient is a known cease of Hypertension, Diabetes mellitus since 2yrs and on medication (propranalol,glimiperide)

No h/o TB, Epilepsy, Bronchial asthma, Thyroid disorders

PERSONAL HISTORY: 

Diet - Mixed

Appetite - normal

Sleep - adequate 

Bowel movements -regular

Bladder movement: decreased urine output 

Addiction - h/o  90ml alcohol consumption since4yrs for every 10days

GENERAL EXAMINATION 

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



There is presence of pallor , pitting type of pedal edema up to the hip




No cyanosis, clubbing, lymphadenopathy

Vitals on admission - 

Temp - 98'F

BP - 140/90 mm hg 

PR - 104bpm 

RR- 22cpm 

Grbs-253mg/dl

SYSTEMIC EXAMINATION:

CVS: S1, S2 heard , no murmurs 

RS:BAE present , vesicular breath sounds are heard,trachea -central

  P/A- abdominal distension,soft,non tender



diagnosis:anasarca secondary to  decompensated chronic liver disease 

Type-2 Diabetes mellitus

Hypertension

Microcytic hypochromic anemia

Treatment given:

Inj.lasix 40mg iv/bd

Inj.spironolactone 50mg od

Inj.pan40mg iv/od

Inj optineuron 1amp in 100 ml ns iv/od

Tab rifagut 500 mg po/od

Tab.hepamerz po/od

Tab.orofer xt po/od

Inj.hai sc/tid

Syl.lactulose 20ml/hs

Inj.thiamine  1amp in100ml ns iv/bd

Daily three egg whites 

Grbs on 12-12-23 and 13-12-23


Done on 11-12-23






On12-12-23 (diagnostic paracentesis wsa done)





Endoscopy done to rule out oesophageal varices



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