22 year old Female presented with Decreased Urine output and pedal Odema

 

 MEDICINE CASE 

  DISCUSSION

 

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FINAL PRACTICALS

Name - Samudrala Kavya sree

Hallticket no - 1701006164

Case discussion

A 22 year old female who is farmer by occupation, presented with the complaints of 

Generalised swelling of body since 5 days

Initially decreased  urine output followed by no urine output since 5days

  

 

 

History of presenting illness

Patient was apparently asymptomatic 12 years back, then she had polyuria, polydypsia and polyphagia for which she was taken to local hospital and diagnosed with diabetes at the age of 12years and from then onwards she is on regular medication isophane insulin. 

1year ago she went for the routine checkup and she was diagnosed with hypertension and she is kept on medications telma 40mg and tab nicardia 20mg . 

patient presented to us on 25th may 2022 with the complaints of pedal odema, facial puffiness, decreased urine output and she underwent dialysis for 5times, antibiotics,diuretics,telma, insulin was given and discharged on 4th june 2022 with advice of salt and water restriction and protein diet is adviced.

Now patient presented on 10th june 2022 with the complaints of generalised swelling of the body since 5days initially involving face and periorbital region and later legs from ankle to thigh also upperlimb and abdomen are involved .

 Swelling was insidious in onset, gradually progressive in nature no aggravating or relieving factors.

 She also complains of Reduced urine output initially for 3 days followed by no urine output since 2days. No history of burning micturition. 

No history of fever , abdominal pain, no history of nausea, vomiting, headache, no history of bonepain

Past History

She is a known case of diabetes and on regular insulin since 12 years, also known case of hypertension since 1year and kept on telma 40mg and nicardia 20mg . 

No history of Tuberculosis, asthma, epilepsy, CVD . 

Personal history

Diet - mixed diet,

appetite is reduced from 10days 

Bowel and bladder - bowel is regular and decreased urine output since 5days. 

Sleep - adequate

 No known allergies

Family history

No history of diabetes or hypertensiom in the family members

General Examination

After taking consent , patient was examined in a well lit room after adequate exposure. She is conscious, coherent, coperative. Moderately built and nourished . Well oriented to time place and person. 

On Examination she has pallor and pitting type of odema. 

 

 

No icterus, cyanosis, clubbing, lymphadenopathy 

vitals 

Temperature - Afebrile

 pulse 100bpm 

Respiratory rate - 20cpm 

Blood pressure - 140/90 mm Hg measured in supine position and in left upper arm 

Spo2 - 97%

GRBS- 220mg/dl

Systemic Examination 

Per Abdomen Examination

 

 

 

*Inspection :

 Abdomen -distended and flanks full, 

umblicus inverted and central in position .

No visible veins no scars and sinuses

*Palpation :

soft and nontender

 no organomegaly, 

Fluid thrill present 

* percussion : 

Dull note heard over the abdomen

*Auscultation :

 bowel sounds +, no bruits

Respiratory system 

Inspection 

shape of the chest -bilateral symmetrical, movements are equal on both the sides, trachea appears to be in central in position . 

Palpation - Decreased movements of chest in the both lowerlobes (infraaxillary and infra scapular)

 vocal fremitus decreased in infra axillary and infrascapular area on both sides 

percussion- stony dullness in infraaxillary and infrascapular area on both sides 

Auscultation - Absent breath sounds on both lower lobes ISA and IAA, vocal resonance over both lower lobes. 

CVS - S1 S2 heard, No murmurs 

CNS - intact, Higher mental functions are normal,Motor and sensory system normal, No meningeal signs.

Diagnosis  

Diabetic nephropathy with bilateral pleural effusion with ascitis.

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 - normochromic and normocytic

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 rapid test non reactive 


USG : FINDINGS 

*B/l grade 2 RPD 
*Gross ASCITES
*B/L MODERATE to gross PLEURAL EFFUSION.

 

 

xray

 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 .

Investigations on 11/6/22.

Hemogram:
•Hb-6.2g%
•Blood urea-127 mg/dl
•Serum creatinine -6.7mg/dl

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