50 Year old female with fever and bilateral pedal edema

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

This E-book also reflects my patients centered online learning portfolio and your valuable comments in comment box are most 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 and to comprehend clinical data including history, clinical finding investigations and come up with a diagnosis and treatment plan.


20-8-2022


A 50-year-old female patient came to the casualty with the cheif complaints of fever and swelling of both the legs since 3 days.


History of present illness :


H/o Fever-

Onset - insidious

Duration- since 4 days

Type - intermittent 

 Associated with chills and rigors.

Diurnal variation present

Increased temperature at night


H/0 constipation for 2 years

Passes stools once every 3 days


H/0 loose stools 4 days back

6 episodes

Non-blood stained

Mucus is present.


Bilateral pedal edema since 3 days

Pitting type


Burning micturition present

No history of shortness of breath


Past history 

Not a known case of, 

Hypertension, diabetes, epilepsy, CAD, asthma, thyroid.


Personal history :

Diet - mixed

Appetite - normal

sleep - adequate

Bowel and Bladder movements - regular

Addictions - no

No known allergies

Drug history : 

No significant drug history

Family history :

No significant family history

General examination :

Patient is conscious ,coherent ,cooperative and was well oriented to time ,place and person 

at the time of examination

He is examined in a well lit room, with consent taken.

He is moderately built and well nourished.

Pallor - absent

Icterus - absent

Cyanosis - absent 

Clubbing - absent

lymphadenopathy - absent

Pedal edema - absent

Vitals : on the day of admission (20/8/2022)

Temperature - Afebrile

Pulse rate - 96 bpm 

Respiratory rate - 16 cpm

Blood pressure - 120/70 mmHg

SpO2 - 98% on Room air

GRBS - 101 mg/dl





Systemic examination :


CVS : S1 and S2 heart sounds heard

No murmurs and thrills

RESPIRATORY SYSTEM : Bilateral air entry present position of trachea - Central 

Vesicular breathsounds heard

CNS : intact

ABDOMEN : Soft and non tender

              No palpable masses

              Bowel sounds heard 

              NO organomegaly 

Investigations :

On the day of admission (20-8-22)


X Ray



USG

ECG


HAMEOGRAM 

BLOOD GROUPING 

DENGUE TEST 


URINE ANALYSIS 

Provisional diagnosis:

Fever with thrombocytopenia

Treatment:

1.IVF - ns, RL @75ml/hr
2.Tab. Pan 40mg PO/OD
3.Tab. Zofer 4mg PO/ BD
4.Tab. paracetamol 650mg PO/TID
5.INJ. Neomol IV / SOS if temp >102°
6Temperature monitoring 4th hourly
7.Strict vitals monitoring - BP,PR 2nd hourly











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