Generalised body swelling

 AMC 1st bed


A 70 yr old male farmer came to the OPD with the C/o-

SOB since 10 days- ORTHOPNOEA. ,PND. , since 10 days

Decreased urine output since 12days

Scrotal swelling since 12 days

Generalised swelling of body since 12 days

Facial puffiness since 12 days

C/o constipation since 12 days (passing stools only on medication)


patient was apparently alright 1 yr back

When developed - 

Cellulitis of right lower limb (due to DM-II)


On 15/10/21 - 

He developed swelling of the right leg till the knees and facial puffiness, for which he visited doctor and was treated for the same and it subsided later on. 

On 16/10/21- 

on usg - mild left pleural effusion


On 15/11/21- 

Generalised body swelling, scrotal edema,  decreased urine output and after 2 days

SOB 


ON 16/11/21- 

He visited the doctor and 

on usg -

scrotal wall cellulitis

RBS- 279

Blood urea- 97

Raised serum creatinine-3.6mg/dl 

Serum Utica acid- 7.6mg/dl

LFT- within normal range, albumin-3.5

He was treated with- 

Inj.cefaoish (cefoperazone and sulbactam)

T.metrogyl

T.dytor 10mg 

T.amlong 10mg

T.Nodosis

T.nephrosave 

Nebulisation with formonide

T.ecospirin 75mg

Inj.hai 12u———10u 

T.chymeral forte 

Scrotal support bandage


And 1 PRBC TRANSFUSION DONE. 


On 17/11/21- 

Hb- 9.4

Blood urea- 96

Serum creat- 2.6


past history

H/o RT LL CELLULITIS (due to DM-II) one year back. Got treated with various antibiotics (meropenem etc) and tramadol for pain for around 3-4 months. 


DM(+ - diagnosed 20 hrs back) ,  HTN(-)

On 16/11/21 he was told to have recovered from accelerated HTN


personal history

appetite-normal

addictions- none

bowel movements- was normal until 16/11/21 when he developed gastritis and constipation and wouldn’t pass stools for 4 days. And on taking medication he would pass stools. 

Till now (from 16/11-27/11) stools passed- 5 times.

micturition - decreased urine output since 5 days


no significant family history


general examination

pallor-present

icterus-absent 

Edema- generalised body edema (pitting type) present 

NO clubbing,cyanosis, lymphadenopathy 

pulse-85/min

Rr-19cpm

BP- 110/70 mmHg

spo2 - 98%

CVS

s1,s2 heard

RS :

BAE + ,NVBS 

P/A- soft, non-tender

No guarding or rigidity, BS +














B/l scrotal edema (Scrotum enlarged diffusely) ; PENILE EDEMA +

No local rise of temperature

No tenderness, no c/o cellulitis


CNS: 

NAD


provisional diagnosis:

SOB UNDER EVALUATION WITH SCROTAL SWELLING ; k/c/o DM

INVESTIGATIONS- 












DIAGNOSIS - 
HFEPEF WITH moderate MR+/AR+/TR+ with k/c/o DM with scrotal edema , CKD



TREATMENT- 

T.LASIX 40mg BD

Inj. MONOCEF 1gm/IV/BD 

T. OROFER-XT PO OD

T.NODOSIS 500mg BD

T. SHELCAL-CT PO OD

NEB WITH DUOLIN 8th hrly, BUDECORT 12th hrly

T.ECOSPRIN-AV 75/10mg 

T.HYDRALAZINE 12.5mg BD 

STRICT I/O charting 

FLUID AND SALT RESTRICTION

INJ.HAI S/C ACC TO GRBS 

SCROTAL SUPPORT

BP/PR/TEMP CHARTING 4th hrly


After admission into ward the patient developed SOB AND BECAME TACHYPNOEIC(28cpm) with a BP OF 150/100. B/L IAA crepts and wheeze present.

Pt was given lasix 40mg and nebulisation with budecort and Duolin.

Pt then Shifted to AMC and continued with nebulisation.




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