OP case 64 year female with Bilateral pedal Edema
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A 64 year old female house maker resident of nalgonda came to casualty at 10.00 am on 14th December, 2022.
CHIEF COMPLAINTS:-
Bilateral pedal Edema since 15 days
HISTORY OF PRESENTING ILLNESS:-
patient was apparently asymptomatic 10days ago and then she developed bilateral pedal edema which is insidious in onset,gradually progressive, pitting type which is extending upto the knee(grade 2) associated with itching.
No aggravating and relieving factors.
History of nocturia (3-4times),snoring.
Not associated with abdominal distension, shortness of breath,cough,palpitations,chest pain,
No history of headache, blurring of vision.
PAST HISTORY
•she is known case of hypertension since 10 years
•Diabetes mellitus since 10 years
•History of humerus fracture 2 years ago which is treated conservatively (because of fall from steps)
•History of psoriasis 4 years ago (she had 3 lesions on scalp got treated in our hospital)
PERSONAL HISTORY
Diet- mixed
Appetite-normal
Sleep- adequate
Bowel movements-regular
No addictions
DAILY ROUTINE
she wakes up at 8 AM everyday and do her everyday rituals then she would have her breakfast at 10 AM.
She will not do regular household works(her maid will do).
She passes her day by running kiranam store.She takes her lunch at 1PM followed by short nap of 1hour,dinner at 8 PM and goes to sleep at 10 PM.
FAMILY HISTORY
her husband is also known case of hypertension and diabetes mellitus.
GENERAL EXAMINATION
Patient is conscious, coherent and cooperative well oriented to time, place and person. She is obese and moderately nourished.
No pallor,icterus,cyanosis,clubbing,
lymphadenopathy.
VITALS
Temperature - 98.4°F
BP - 150/80mm of Hg
Pulse rate - 78bpm
Respiratory rate -18 cpm
GENERAL EXAMINATION
CVS
INSPECTION
Shape of chest- bilaterally symmetrical
Trachea - central
No visible pulsations
No scars,sinuses or dilated veins
PALPATION
No thrills,parastrenal heaves
AUSCULTATION
s1,s2 are heard
No murmurs
No raised jvp.
RESPIRATORY SYSTEM
Bilateral air entry present
Normal vesicular breath sounds are heard
PER ABDOMEN
soft,non tender,no organomegaly
CNS
No focal neurological deficit
INVESTIGATIONS
ECG
2D ECHO
TREATMENT
At 11:35 AM in OP NICARDIA 20mg was given
After 30 minutes BP was recorded-200/100 mm of Hg
And then on 15th morning 08:00am it was 160/90mmhg
After admitting in the ICU then
LABETOLOL IV and TELMA H given
DIAGNOSIS
Hypertensive urgency ??
Day 3 in ICU
Examination :
Pt is c/c/c
Afebrile
PR 96 bpm
BP 150/90
CVS: s1 s2 +
RS: BAE + , NVBS
P/A: obese , soft , NT
CNS: NFND
Grbs: 210 mg/ dl @8 am
Diagnosis
HYPERTENSIVE URGENCY WITH UNCONTROLLED HYPERTENSION ?
Management:
1.inj.labetolol 20 mg IV/ sos of SBP >160 mmHg
2.T.Telma-H PO/OD
3.T.cinod 10 mg PO/BD
4.T.Metformin 500 mg PO/BD
5.T.Met-XL 50 mg Po/OD
6.T.Minipress XL 2.5 mg Po/OD
7.2 Hourly Bp monitoring
8.vitals Monitoring 4 th hourly
After shifting to AMC day 4
Examination
Pt is conscious ,coherent , cooperative
Temp: afebrile
BP: 120/80mmHg
PR : 88bpm
RR :18 cpm
GRBS 194 mg/dl
CVS : S1 S2 +
RS : BAE +
CNS :NAD ,HMF+
P/A : Soft and nontender
Provisional diagnosis
HYPERTENSIVE URGENCY ,
?HYPER TENSIVE CRISIS
? METABOLICSYNDROME
? SEVERE UNCONTROLLED HYPERTENSION
?PVD
H/O PSORIASIS SINCE 6 YEARS
K/C/O.HYPER TENSION AND DM 2 SINCE 10 YEARS
Management
tab metformin 500 mg po/bd
tab cinod 10 mg po/ bd
tab met xl 50 mg po/ od
tab minipress xl 2.5 mg po/od hs
bp monitoring 2 hrly
vitals and grbs 6 hrly
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