60 year old with anasarca and severe anemia with RHF
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DR. JAYANTH ( INTERN)
DR. AMULYA ( INTERN)
DR. SURYA PRADEEP ( INTERN)
DR. ASHA KIRAN ( INTERN)
DR. YAMINI ( INTERN)
DR. VAMSHI ( INTERN)
DR. ISMAIL (INTERN)
DR. PRADEEP ( PG 1st YEAR)
DR. NIKITHA ( PG 2nd YEAR)
DR. SUFIYA ( PG 3rd YEAR)
DR. SATISH ( PG 3rd YEAR)
Faculty : DR. VIJAYALAXMI
Here is a case i have seen:
60 years old female who is a daily wager came to the OPD with c/o
1. Facial puffiness progressed to generalized swelling since 5months.
2. SOB grade II to IV progressively increased since 3 months.
3. C/o SOB on lying down since 1 month.
4. C/o cough since 1month.
5. C/o low grade fever since 1month.
Patient was apparently alright 5 months back then she started having facial puffiness which progressed to anasarca which was associated with SOB on doing acustomed work gradually progressed over a period of 2 months to SOB even at lying down. Later accompanied by dry cough which increased more during the midnight especially on lying down associated with pain in the coastal margin prior to this she was constantly exposed to cold environment which was associated with low grade fever. Not associated with chills and rigors.
No h/o weight loss, lethargy, joint pains, burning micturition.
No h/o PND and palpitations.
H/o of trauma (hit by vehicle) to head 9 years back.
GENERAL EXAMINATION-
Patient is c/c/c.
Generalised swelling present.
Bilateral pedal edema present, pitting type.
Pallor present.
No signs of icterus, cyanosis, clubbing, lymphadenopathy.
Vitals-
Afebrile
BP- 110/80mmhg
PR- 80bpm
RR- 19cpm
SpO2-87% on RA
99% on 2L O2
SYSTEMIC EXAMINATION-
CVS-
S1 S2 present.
Thrills present in Right parasternal region.
Diffuse apex present.
JVP increased upto the angle of mandible.
RS-
B/L air entry present.
Vesicular breath sounds.
Position of trachea- Central.
Wheeze is present- End expiratory rales in b/l inframammary and Right infra-axillary area.
Grade IV dyspnea present.
PA-
Abdomen is distended with flat umbilicus.
Lower segment > upper segment.
Tenderness present in left iliac predominantly.
Shifting dullness is present.
No palpable mass and hernial orifices are normal.
Bowel sounds are heard.
Liver and spleen not palpable.
CNS-
Concious with normal speech .
No signs of meningeal irritation.
No motor, sensory and cranial nerve deficits.
GCS- 15/15.
Provisional Diagnosis- DENOVO HYPOTHYROIDISM WITH IRON DEFICIENCY ANEMIA (?NUTRITIONAL) WITH RIGHT HEART FAILURE WITH HYPOALBUMINEMIA (?NUTRITIONAL).
TREATMENT- On day of admission
1. Fluid restriction less than 1.5L/day till
further evaluation.
2. Strict I/O charting.
3. BP, PR, temperature hourly monitoring.
4. Oxygenation to maintain SpO2 >90%.
5. Nebulisation with ASTHALIN 8th hrly
and BUDECORT 12th hrly.
6. Chest physiotherapy.
TREATMENT ON DAY 2- 10/02/2021
1. Fluid restriction < 1.5L/day.
2. Salt restriction to <2gm/day.
3. Nebulisation with ASTHALIN 8th hrly
and BUDECORT 12th hrly.
4. Inj. LASIX 40mg IV BD if SBP
>110mmhg.
5. Oxygenation to maintain SpO2 >90%.
6. Syp. ASCORIL 15ml TID.
7. T. MONTELEUKAST LC BD.
8. Syp. LACTULOSE PO BD.
9. Protein rich diet.
TREATMENT ON DAY 3- 11/02/2021
1.Fluid restriction to <1L/day. Salt restriction to <2gm/day.
2. Nebulisation with ASTHALIN 8th hrly and BUDECORT 12th hrly
3. Inj. LASIX 40mg IV BD if SBP >110mmhg
4.Syp. ASCORYL 15ml TID.
5. T. MONTELEUKAST LC BD.
6. Syp. LACTULOSE PO BD.
7. Protein rich diet.
8. OXYGENATION TO MAINTAIN SPO2 >90%.
9.I/0 CHARTING.
10.TEMP/BP/PR HOURLY MONITORING.
11.T.PCM 500mg PO SOS.
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