26yr old female with pedal edema and facial puffiness

 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.

Case presentation:

A 26 year old female patient who is a house wife and resident of kalampalli came to general medicine opd with complaints of  c/o bilateral pedal edema since 21days.

The patient was apparently asymptomatic one month back later she had LSCS for her first pregnancy and gave birth to  a baby who was kept in NICU for a day and then declared dead due to birth asphyxia.

Then she noticed bilateral pedal edema pitting type which is insidious in onset gradually progressing not relieved by rest present upto knee associated with orthopnea and facial puffiness.

H/o fever 20days back which was high grade associated with chills and rigors 

No H/o loose stools ,vomitings.

O/E patient is c/c/c

BP 160/80MMHG

PR 98BPM

AFEBRILE

CVS -S1,S2 HEARD 

RS  - BLAE PRESENT 

PA-SOFT NON TENDER 

INVESTIGATIONS:

20/10/2020












Chest xray 
OBG REFERRAL: 20/10/20


26/10/20

21/10/20

DERMATOLOGY REFERRAL - 21/10/20




DIAGNOSIS: 
POSTPARTUM CARDIOMYOPATHY HEPEF WITH DENOVO HTN WITH ANASARCA WITH ORAL CANDIDIASIS AND HERPES SIMPLEX (HEALED)

TREATMENT 

20/10/2020
INJ LASIX 40mg IV BD
TAB METXL 25MG OD PO
SALT RESTRICTION<2g/day
Syp CREMAFFIN PLUS 15ML IN ONE GLASS WATER

21/10/2020
INJ LASIX 40mg IV BD 
INJ OPTINEURON IM BD
TAB METXL 32.5mg PO OD 
TAB NICARDIA 10mg PO BD
INJ MONOCEF 1GM IV BD
TAB RIBOFLAVIN 20MG OD
SYP CREMAFFIN PLUS 15ml H/S
TAB FLUCONAZOLE 150mg OD 
CANDID MOUTH PAINT L/A 
FLUID AND SALT RESTRICTION 
DAILY WEIGHT AND VITALS MONITORING

SAME TREATMENT ON 22/10/2020 and 23/10/2020

24/10/2020
INJ PANTOP 40mg IV OD
INJ MONOCEF 1GM IV BD
TAB METRONIDAZOLE 500mg TID
TAB AMOXICLAV 625mg BD
TAB RAMIPRIL 5MG OD
TAB METXL 25mg OD
TAB RIBOFLAVIN 20MG OD
CANDID MOUTH PAINT LA
INJ OPTINEURON 1AMP IN 100ML NS IV OD 
INJ THIAMINE 100mg
TAB VIT C 500mg OD
INJ LASIX 40MG IV BD
VITALS MONITORING

25/10/20 , 26/10/20, 27/10/20 same treatment as above.






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