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A 38 year old female patient,shop worker,presented to the opd with the chief complaint of Irregular menses since 2 years,Pruritic rashes since 1 month, pedal edema, shortness of breath since 15 days & decreased urine output since 15 days.
Patient was apparently asymptomatic 21 years back from then she was having irregular menses.She attained her menarche when she was 14.Till her inter i.e, she was 18 years her cycles were normal.After that she was having on & off menses.She user to get her menses once in every 2-3 months & lasts for 15-20 days.
2 years back when she didn’t get her menses for 6 months,she took some homeopathic medication following which her menses were regular for the next 6-8 months.After that again she had again irregular menses even with the use of herbal medication,till now.
Since 1 month she had itchy lesions all over the body with few pus points on lower limbs visited local doctor used few topical medications but no relief in her symptoms.
15days back she suddenly woke up from sleep due to shortness of breath,went to local hospital & got treated.Then she experienced that she had b/l pedal edema associated with decrease urine out put.Next day they went to gynecologist doubting that her irregular cycles may be reason for her shortness of breath.There she got her CBP done which showed severe anemia & blood transfusion was adviced.So now for further evaluation & treatment she came here.
The patient was not a known case of hypertension,diabetes mellitus,bronchial asthma,epilepsy & tuberculosis.No history of any surgeries.
Personal history:
Occupation - Shop worker
Mixed diet
Bowel & bladder - Decreased urine output
Sleep adequate
No addictions
Appetite -normal
Family history:
No significant family history
General Examination:
The patient is conscious,coherent and cooperative.She is well oriented to time,place and person.
Pallor
No Icterus
No Cyanosis
No Lymphadenopathy
Pedal Edema present,hyperpigmented papules with pus points.
Vitals
Temperature-97.4 degree F
Pulse rate-114 beats/min
Respiratory Rate- 18/min
Blood pressure- 110/70 mmHg
SpO2 - 99% at room temperature
GRBS -82 mg/dl
Pallor
Pale palm
Bald tongue
Hyperpigmented papules over body with pus points on lower limbs
Systemic examination:
CVS :
S1 S2 +
JVP - elevated
No thrills
RS- BAE + , NVBS heard
per abdomen- Normal hernial orifices
Non tender,No organomegaly
CNS- Conscious,Speech normal.
Provisional Diagnosis:
Investigations :
HBsAg-RAPID:
Negative
HIV 1/2 Rapid Test:
Non Reactive
Anti-HCV Antibodies Rapid:
Non Reactive
Blood parasites
Malarial parasite - Negative
Haemogram:
On 3/12/2021
Liver Function Test:
ABG :
Ultrasound on 3/12/2021
B/L kidney size deceased and echogenicity increased, CMD lost.
B/L grade 3 RPD changes,
B/L minimal pleural effusion
Ultrasound on 8/12/2021
Retic count : 0.7
Absolute retic count : 0.2
Reticulocyte index : 0.09
Indicates hypoproliferative marrow.
Renal Function Tests :
Serum Creatinine- 14.3 mg/dl
Blood urea - 250 mg/dl
LDH :
490.7 IU/L
Serum electrolytes :
Sodium - 141 mEq/L
Potassium - 4.2 mEq/L
Chloride- 98 mEq/L
Treatment:
4/12/2021
Inj LASIX 40mg IV
Inj PAN 40mg IV
Tab Zofer 4mg IV
Tab Nodosis 400mg
Tab Shelcal 500mg
Venusia Max lotion
Oint T.BACT
5/12/2021
Inj LASIX 40mg IV
Tab PAN 40mg IV
Tab Zofer 4mg IV
Tab Nodosis 400mg
Tab Shelcal 500mg
Venusia Max lotion
Oint T.BACT
6/12/2021
Inj LASIX 40mg IV
Tab PAN 40mg
Tab Zofer 4mg IV
Tab Nodosis 400mg
Tab Shelcal 500mg
Venusia Max lotion
Oint T.BACT
7/12/2021
Inj LASIX 40mg IV
Tab PAN 40mg
Tab Zofer 4mg IV
Tab Nodosis 400mg
Tab Shelcal 500mg
Venusia Max lotion
Oint T.BACT
8/12/2021
Inj LASIX 40mg IV
Tab Nodosis
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