ANASARCA

This is 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 patients 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 comment box is welcome. 

 I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

CHIEF  COMPOAINTS:
C/o facial puffiness since 5 months 
C/o bilateral swelling of lower limbs since 5months 
HOPI :
patient was apparently asymptomatic 5months ago then developed facial puffiness which was insidious,on and off only in morning, gradually decreased by night followed by pedal edema in both legs extends upto mid-thigh, pitting type, gradually progressive.
H/o  shortness of breath class 2NYHA abdominal distension swelling of both hands.
No h/o  decreased urine output, fever
No h/o chest pain, palpitations
No h/o cough,cold, constipation
No h/o rash , itching
PAST HISTORY
K/C/O nephrotic syndrome secondary to membranous nephropathy ( serological diagnosis) since 1 year 3 cycles of modified ponticelli regimen Was given and on regular medication.
K/C/O HTN since 2 years was on TAB clonidine 0.1mg PO/OD ,TAB CINOD 10mg PO/BD ,TAB.METXL 25 mg PO/BD
K/C/O DM since 2 years was on TAB.LINAGLIPTIN 5mg PO/OD
N/K/C/O epilepsy , thyroid disorders,CVACAD,ASTHMA,TB
GENERAL EXAMINATION
Patient is conscious coherent cooperative
No pallor, icterus,cyanosis, clubbing, pedal edema present on both lower limbs
VITALS
BP 130/80mmhg
PR 88 bpm
RR 18cpm
SPO2 98%
Temp 96F
CVS: S1S2 heard no murmurs 
CNS:BAE + ,NO added sounds 
RS: 18cpm
P/A soft scaphoid and no distension nephrologist opinion I/v/o nephrotic syndrome
Adv- T .WYSOLONE 50MG PO/OD
TAB TELMA -40MG PO/OD
TAB . MYCOPHENOLATE 500MG PO/OD
OPHTHALMOLOGY REFERRAL I/v/o diabetic retinopathy changes: normal fundus study,no retinopathy changes
COURSE IN THE HOSPITAL
 65yr old male came with complaints of generalised swellings of lower limbs,upper limbs, abdominal distension.on further history taking pt was diagnosed to have nephrotic syndrome secondary to membranous nephropathy ( serological diagnosis,serum PLA2R+) modified ponticelli regimen was started in July 2023 and 3 cycles were given,but patient discontinued follow up since march and on irregular medication.on further investigations pt was found to have proteinuria nephrology opinion was taken and advised TAB WYSOLONE 5 mg po/of,TAB .MET XL 50mg po/od,TAB TELMA -40mg po/od ,TAB. MYCOPHENOLATE 500mg po/od . Biopsy couldn't performed due to presence of renal cysts.
Patient vitals are stable at the Time of  discharge.
INVESTIGATIONS
Hemogram 
CUE
RFT
LFT
FBS
LIPID PROFILE 
24hrs urinary creatinine 
pT
APTT
SPOT URINE PROTEIN AND CREATININE 

URINARY PROTEINS (24HRS)

Thyroid profile 
SEROLOGY

TREATMENT:
Fluid restriction < 1.5 L/day
Salt restriction <2gm/ day
INJ MONOCEF 1GM IV BD
INJ PAN 40MG IV OD
INJ.  LASIX 40MG IV TID
TAB  CLONIDINE 0.1 MG PI/OD
TAB WYSOLONE 5 MG PO/OD
TAB MYCOPHENOLATE MOFETIL 500MG OD
TAB TELMA 40MG PO/OD
TAB MET XL 50G PO/OD
TAB LINAGLIPTIN PO/OD

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