Case history 4

 CASE HISTORY 4

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A 30 year old Male patient  presented to OPD with a chief complaint of  : 

 1. pedal edema since 1 month .

 2.  shortness of breath since 1 month .


HISTORY OF PRESENT ILLNESS  : 

Patient was apparently asymptomatic 1 month before 

And then developed pedal edema and shortness of breath .

Pedal edema is of pitting type .

There is presence of abdominal distension 

And presence of abdominal pain since 1 month and the pain is relieved by taking medication .

Patient complains of cough with sputum since  1 month 

And also complains about high grade fever and chills since 2 days .


PAST HISTORY  : 

Patient had a similar complaint 10 years back and he is a known case of anemia 

And he got blood transfusion once 

He has no history of hypertension,  asthma,epilepsy and diabetes. 


PERSONAL HISTORY : 

Diet - mixed 

Appetite - decreased 

Sleep is adequate 

Bowel and bladder movements are normal 

No history of alcohol and smoking habits .


GENERAL EXAMINATION :

  Patient consent was taken and he is conscious, coherent and cooperative and examined in well lit room .

Pallor - positive 

Icterus - present 

Bilateral pitting edema is seen and it is pitting type

No cyanosis and clubbing is seen 

Abdominal distension is seen .





 VITALS  :

Temparature :- Afebrile

Bp :- 110/50 mmHg

PR:-100beats per min

RR :- 20 cycles/min

Spo2:- 98

SYSTEMIC EXAMINATION:

  CVS : S1 and S2 heart sounds are normal

  Respiratory : Bilateral air entry is normal

             Soft , non tender , mild hepatomegaly are seen with percussion/ auscultation

CNS : Normal 


INVESTIGATIONS :

         ECG : 



         ULTRASOUND:



         CHEST X - RAY : 



OTHER INVESTIGATIONS  : 





















 PROVISIONAL DIAGNOSIS : 

         Anemia secondary to vitamin B - 12 deficiency with thrombocytopenia. 


TREATMENT  : 

1)Bp/PR/Temp 4th hrly

2)inj.Vit B12:1500mcg IV/OD

3)Inj.Lasix 40mg iv/BD

4)Tab.PCM 500mg /sos

5)Fluid restriction <1.5 L/day

6)fever charting.




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