CASE OF AN 80 YEAR OLD FEMALE WITH COMPLAINTS OF SOB, DECREASED URINARY OUTPUT, ABDOMINAL DISTENTION, BILATERAL SWELLING OF LOWER LIMBS SINCE 1 WEEK
CASE:-
An 80 year old female came to the hospital with complaints of shortness of breath, decreased appetite, decreased urinary output, abdominal distension, bilateral swelling of lower limbs since 1 week.
CHIEF COMPLAINTS:-
Shortness of breath, decreased appetite, decreased urinary output, abdominal distension, bilateral swelling of lower limbs since 1 week.
HISTORY OF PRESENT ILLNESS:-
The patient was apparently asymptomatic 20 days ago.
She then had complaints of generalized weakness of body, decreased appetite, difficulty in passing stools (once in 3 days). Later, the patient had complaints of bilateral swelling of lower limbs, pitting type, up to the knee. She also had decreased urinary output, abdominal distension.
She went to a local hospital and her symptoms didn't subside. She later went to another hospital. Since the past 3 days, the patient had complaints of cough with sputum, white in colour, mucoid.
The patient is a known case of post pulmonary tuberculosis 15 yrs back and she used prescribed medication.
The patient is a chronic alcoholic, daily 90ml/day. She is also a chronic smoker.
TREATMENT HISTORY:-
No history of diabetes, hypertension, CAD, asthma, surgeries, blood transfusions, chemo/radiation, hormones.
She is a known case of tuberculosis 30 years ago and used antituberculous drugs for 4-6 months.
PERSONAL HISTORY:-
Appetite: decreased
Diet: vegetarian
Bowels: constipation (passes stools once in 3-4 days)
Micturition: decreased urine output
Addictions: She occasionally drinks 90-180ml of whiskey. Her last smoking binge was 3-4 cigarettes in 10 days.
FAMILY HISTORY:-
No family history of diabetes, hypertension, heart disease, stroke, cancers, tuberculosis, asthma.
GENERAL EXAMINATION:-
No cyanosis, lymphadenopathy, icterus, clubbing of fingers/toes.
Pallor and oedema of feet were observed.
VITALS:-
Upon arrival at the hospital, the following were recorded:
Pulse rate: 110bpm
BP: 80/40mmHg
SPO2: 70
These values have been changing as logged below:-
SYSTEMIC EXAMINATION:-
CVS: S1, S2 sounds heard
Respiratory system: dyspnoea and wheeze present, position of trachea - central, breath sounds-vesicular. Decreased air entry in right IAA, IMA, ISA. Inspiratory creps in left IAA, IMA, ISA.
Abdomen: Shape of abdomen is scaphoid. Bowel sounds heard.
CNS: The patient is alert.
INVESTIGATIONS:-
Bacterial culture and sensitivity report - blood:-
PROVISIONAL DIAGNOSIS:-
Acute Kidney Injury (sepsis induced) with right heart failure, with congestive hepatopathy, with post TB sequale (chronic fibrosis and collapse), with mixed respiratory failure.
CROSS CONSULTATION NOTES:-
TREATMENT GIVEN:-
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