45 yrs old female with hypothyroidism

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Pedal edema

Hypothyroidism

45 year old female patient  presented to OPD with a chief complaint of  : 

 1. Fever since 5 days .

 2. Vomiting and headache since 4 days .

 3. Shortness of breath since 2 days .

HISTORY OF PRESENT ILLNESS :

          Patient was apparently asymptomatic 5 days back .

And then developed fever which is sudden in onset and gradually increasing . 

Fever is not associated with chills and sweating .

Fever associated is on and off since 1 month .

History of vomiting since 4 days in which food particles are present as content .

 History of shortness of breath since 2 days which is more during walking or doing some work .

Bilateral pedal edema is seen which is pitting type .

Loss of appetite is seen .

PAST HISTORY : 

there are no similar complaints in the past .

No history of diabetes , epilepsy , asthma , 

PERSONAL HISTORY :

Diet - mixed 

Appetite - decreased

Sleep - adequate 

Bowel and bladder movements are normal 

Menopause since 1 year .

FAMILY HISTORY : 

There are no similar complaints in the family members .

TREATMENT HISTORY : 

patient took medicines for fever and vomiting suggested in the local hospital .

GENERAL EXAMINATION : 

 Patient consent was taken and she is conscious, coherent and cooperative and examined in well lit room . And well oriented to time and place 

Patient is poorly nourished and built 

No cyanosis

No clubbing

No icterus

No generalised lymphadenopathy 

Pedal edema is seen which is of pitting type and subsided gradually 

VITALS : 

Temperature: afebrile

Blood pressure: 110 / 90 mmHg 

Pulse rate : 84 beats per minute

Respiratory rate : 18 cycles per minute

SPO2 : 98 % in room air 

SYSTEMIC EXAMINATION :  

RS : BAE is positive 

CVS : S1 and S2 are heard 

PA : soft and non tender

CNS : NAD 

JVP : increased 

PROVISIONAL DIAGNOSIS : 

Right upper lobe consolidation 

Lobar pneumonia 

Pre renal AKI 

Hypoalbuminemia 

Hyperthyroidism 

TREATMENT : 

1. Oxygen inhalation to maintain SPO2 > 98%

2. NEB - duolin - 8th hourly

               Budecort - 12th hourly 

3. Inj . Piptaz 2.25 gms /Iv / Tid 

4. Inj. Zofer 4 mg / Iv / sos

5. Tab PCM 650 mg/PO/BD 

6. Syrup acscoryl 10 ml / po / tid

7. Tab . Lasix 20 mg/PO/BD

8. Inj. Pantop 40mg / Iv / OD

9. Tab . Carbimazole 10mg / Po 

10 . Tab .propanolol 20 mg/PO/OD

11. Temperature charting for every 4th hourly 

12. Blood pressure , pulse rate , SPO2 charting every 4th hourly .

Ecg

Liver functioning test

Color Doppler 2D echo test

Ultrasound