35 yr female with shortness of breath
A 35 year old female from marapaka, came to casualty with c/o shortness of breath since 20 days.
History of present illness :-
Pt was apparently asymptomatic, 2 months back then she developed breathlessness which is insiduous in onset since 20 days which aggrevated on performing physical work and was relieved on rest. Then she visited a local hospital in miryalaguda, on evaluation she had low hemoglobin count and 2 blood transfusions were done and was given medicines for a week. After using these medicines for one week she developed bilateral pedal edema (pitting type). So she visited a hospital in guntur. As there are no aarogyasri services in guntur she came back to nalgonda regarding the same issue. She had one more blood transfusion in Nalgonda hospital. Later she developed breathlessness and visited our hospital. She was on medication and her breathlessness subsided after 3 days of admission. She had 5 blood transfusions here and was on dialysis(10). Pedal edema did not subside after dialysis and also had a complaint of abdominal tightness.
History of past illness :-
History of abortion two years back followed by four months of amenorrhea and then bleeding for 3 months continuously. Changed five pads per day which were fully soaked and was not associated with pain . Spontaneously subsided 3 months later. No burning micturition and white discharge. No pain in the abdomen.
Personal history:-
Diet- Mixed.
Appetite :- Adequate.
Bowel and bladder movements:- Decreased urine output.
Sleep :- Disturbed
Addictions :- No addictions.
Allergies :- No allergies.
K/c/o HTN since 3 years
Not a k/c/o DM, asthma, TB.
O/E :
pt is concious, cooperative and coherent
Pallor - present
Icterus - absent
Cyanosis - absent
Clubbing - absent
Lymphadenopathy - absent
Pedal edema - b/l present
Vitals:
Afebrile
Bp: 140/100 mm hg
PR: 99 bpm
RR: 22 cpm
SpO2: 87% @RA
CVS: S1,S2 +
RS: BAE+
P/A: SOFT, NON TENDER
CNS: NAD
INVESTIGATIONS :-
On 5/2
On 7/2/22
HEMOGRAM
On 10/2/22
HEMOGRAM
RFT
25/2/22
S:
C/O sob and abdominal distension since last dialysis
O:
Patient was C/C/C
No pallor, icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema
Vitals at admission:
PR- 80 bpm
BP- 140/80 mmHg
RR- 21 cpm
SpO2- 98%
CVS: S1 S2 +,
RS: B/L AE +
P/A: soft nontender .
Ascitic tap was done on 23/2/22 showing high SAAG high protein
SAAG value - 1.8
Ascitic protein - 3.0
A:
High SAAG high protein secondary to heart failure
Recent hemodialysis:
23/2/22
1 PRBC given
Hemodialysis since 1 month 2 sessions per week
P:
1. INJ. LASIX 40 mg IV BD
2. INJ PAN 40 mg IV OD
3. INJ ZOFER 4 mg IV OD
4. INJ erythropoietin 4000 IU SC once weekly
5. MONITOR VITALS
6. Tab OROFER XT PO
OD
7. Tab SHELCAL PO OD
8 T AMLONG 5 mg PO BD
9. T NICARDIA 20 mg PO OD
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