23 year old female with facial periorbital edema and pedal edema.
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A 23 year old female resident of vutikodu farmer by occupation came to OPD with chief complaints :
✓periorbital edema (on and off) since 5 months.
✓Bilateral Pedal edema (on and off) since 5 months.
✓Fatigue since 5 months.
History of presenting Illness:
Patient was apparently asymptomatic 5 months ago.Bilateral Pedal edema which is pitting type since 5 months which was insidious in onset, gradually progressive in nature, aggrevated while working in farm and relieved on medications.
H/o periorbital edema early in the mornings, deceased as the day progresses since 5 months ( on and off)
H/o fatigue since 5 months.
No H/o polyuria , nocturia, burning micturition.
No h/o fever ,rash , abdominal pain, vomiting, diarrhoea, constipation.
No h/o difficulty in breathing, palpitations, sweating,chets pain,chest tightness.
Sequence of events:
Daily routine:
She is a farmer by occupation.She wakes up usually around 5:30 am , sweeps in and around her house, cooks,washes clothes and have breakfast by 9 am and goes to field to work by 10 am .She works in farm for 3 hrs in morning,eats lunch around 1pm and takes rest.She will go home around 6pm after working whole afternoon in the farm , prepares dinner ,eat and sleep around 10 pm .
She farms paddy , cotton and Vegetables in her field.
Past history:
Not a k/c/o Diabetes Mellitus, Hypertension, Tuberculosis, Epilepsy,Asthma, Thyroid disorders.
Personal History:
Diet:mixed
Appetite : normal (generally less appetite)
Bowel is regular
Bladder- decreased urine output(reduced to 1time a day)
Sleep:adequate
No addictions
No allergies
Family History:
No significant family history.
Treatment history:
Inj . DURATAZ 4.5 mg
Tab DYTOR 10 mg
Tab. RABTER D CAP
On presentation her vitals:
BP: 110/90 mm Hg
Respiratory Rate: 20 cpm
Pulse rate: 99 bpm regular,no radio radial delay
SpO2:98% on room air.
GRBS: 83 mg /dL .
Temperature: afebrile
GENERAL EXAMINATION:
patient was conscious,coherent,cooperative.
Moderately built and nourished.
well oriented to time,place and person
No pallor,icterus , clubbing, cyanosis,koilonychia , lymphadenopathy.
B/L pedal edema - pitting type present.
On 30 /11/2022
Vitals
Temperature:Afebrile
BP:130/80 mm of Hg
Pulse rate: 80bpm irregular,normal value.
Respiratory Rate:18cpm
Systemic Examination:
Abdominal examination:
Inspection
Umbilicus inverted , No abdominal distention,no visible pulsations,scars and swelling.
Palpation
Soft, non tender, no organo megaly.
Auscultation
Bowel sounds heard
Cardio vascular examination:
No visible pulsations, scars, engorged veins. No rise in jvp
Apex beat is felt at 5 Intercoastal space medial to mid clavicular line.
S1 S2 heard . No murmurs.
Respiratory system :
Shape of chest is elliptical, b/l symmetrical.
Trachea is central. Expansion of chest is symmetrical
Bilateral Airway Entry - positive
Normal vesicular breath sounds
CNS examination: No neurological deficit found.
Gait: normal.
Normal speech.
Provisional Diagnosis:
Nephrotic syndrome under evaluation.
Investigations:
HEMOGRAM
COMPLETE URINE EXAMINATION
24 HOUR URINE (protein: creatinine)
SERUM CREATININE
SERUM ELECTROLYTE
ECG
Treatment:
1.Salt restriction (<2.4 gm/day)
2.Fluid restriction (<1 lit/day)
3.Tab.Lasix 20 mg PO BD
4.Tab .Ramipril 2.5 mg PO/OD
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