60yr female with c/o B/L swelling of lower limbs (pitting type up to knees),facial puffiness since 1week







This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 

This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.
Here is a case i have seen:
A 60 yr old woman ,home maker by occupation came to hosipital with c/o B/L swelling of lower limbs :1 week (pitting type upto knees) ,facial puffiness +:1 week , wound over left foot -small toe :1 week .fever for 1day  3 days back ass with chills relieved with medication .
H/o Decreased urine output
No h/o chest pain/palpitations/sob/giddiness/cough/cold 
No h/o burning micturition
No h/o pain abdomen,vomitings,loose stools
No other complaints
H/o loc 10 days back - taken to govt hosipital (grbs - 40 mg / dl) regained conscious later 
K/c/o type 2 dm :5yr and on metformin 500mg
Not a k /c/o htn / asthma /epilesy /cad/tb 


Personal history: normal appetite,non veg ,regular bowel movements ,normal  urine output. 

General examination: pedal oedema + 
No sign of pallor,icterus,cyanosis,clubbing,lymphadenopathy 
Temp :afebrie, pr: 84/min
RR:20/min
Bp: 110/90mm/hg
Grbs :256 mg %











Systemic examination 

Cvs :s1s2 heard no murmurs
Rs:BAE+,NVBS
P/A : soft non tender ,no oraganomegaly
Cns: conscious,normal speech , cranial nerves intact ,motor and sensory system normal

INVESTIGATIONS
Day 1
Day 1-Day 5 Hg,ser.electrolytes chart

Blood Transfusion was done on 6/12/2020.
Another Blood Transfusion was done on 8/12/2020.

Day 6








Provisional Diagnosis-Hypoproliferative Anemia
                        Hypoalbuminemia
AkI-secondary to ?Lt sided pyelonephritis 
Type 2DM

          Treatment given
1)Fluid restriction with 1lt/day
2)Salt restriction <2.4gm/days
            3)Inj.Lasix 40mg IV/BD(if SBP>110)
         4)Inj.Optineuron 1amp in 100ml NS 
5)Inj.Pantop 40mg IV/OD                                                 
6)Inj.Augmentin 1.2g BD
7)Inj.HAI 10units(8am),
10units(12pm),
8units(8pm)
8)Tab.Riboflavin 10mg OD
9)Zytee gel L/A










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