A 45 year old female with facial puffiness ,pedal edema

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A 45 year old female came to OPD with chief complaints of

1) facial puffiness since 15 days

2)pain abdomen since 15 days

3)body pains and weakness since 15 days

HOPI: Patient was apparently asymptomatic 6 months back then she developed swelling of body and face and did not get any treatment and the swelling resolved spontaneously.

Now patient developed swelling ,facial puffiness since 15 days .

Decreased urine output since 15 days .

No H/O of fever ,SOB ,chest pain

Past history : k/c/o of thyroid disorder (prescribed medication but patient didn't use )

Not a k/c/o DM/HTN/Asthma/TB/Epilepsy

 

8 year ago - during 2nd pregnancy she was diagnosed with thyroid abnormality and was given medication which she used only for 3 months and then stopped .

5 years back during 3 rd child delivery history of increased bleeding during delivery and a/w headache.

All the deliveries were full term normal deliveries .

Child is healthy and normal 

Lactation:

She mentioned that she lactated well after her first delivery and less after 2nd and 3rd delivery compared to the first one.She told that she lactated for 3months post 3rd delivery.But to my surprise during the  breast examination she was still getting milk ( white serous ooze) on squeezing the nipple.I confirmed the history again that is when she told that she is lactating till date but less compared to the previous pregnancies.

Menstrual history : regular and menstruating till date no abnormalities .

Other relevant history:

Patient complaints of occasional giddiness and blackouts with sweating

 (? Hypoglycemia)

Personal History:

Loss of appetite

Bowel & bladder movements - regular

Decreased urine output

Menstrual history :

LMP-6/5/22

Age of menarche -13 

 

Vitals

Temp- afebrile

PR- 86bpm

RR-19Cpm

BP-110/80mmhg

No pallor /cyanosis/clubbing/lymphadenopathy

Edema present

On examination : 

Slight decrease in public hair compared to her previous ( acc to patient)

Breast examination:

No masses were palpable 

Bilateral symmetrical 

Slight decrease in size of both breasts (acc to patient)

Nipple areola complex normal 

On squeezing white coloured serous liquid oozed 

Cvs :s1s2+

RS: BAE +

CNS: NAD

P/A - tenderness in epigastrium, left hypochondrium region

Investigations

Thyroid profile ( our lab)

T3-0.31

T4-0.59

TSH -397.2

Thyroid profile (khl)

T3-0.35

T4-0.56

TSH-452.26

24 UPCR -3700 ml

Na-473

Protein-55.5

Creatinine-0.36

Ratio-0.15

TB-0.47

DB-0.16

AST-28

ALT-17

ALP-79

TP-6.8

Albumin-4.29

A/G ratio-1.71

Hb-9.1

Tlc-4600

Rbc-3.34

Plc-3.72

Pcv-27.7

15/5/22

Serum iron-38

Reticulocyte count-0.7

Peripheral smear- Normal

15/5/22

Free Thyroxine-1.48ng/dl

TSH-158

Chest x -ray

CUE

USG of abdomen

  

 

 

 

Her mother's liver :

Her mother's kidney :

Her brother's liver

Her brother's kidney right side

Her brother's kidney- left side

Provisional diagnosis: Polycystic kidney disease with ? Hypothyroidism

Treatment:

1)Tab.Lasix 20mg PO/BD

2)Tab.Ultracet PO/QID

   1/2-1/2-1/2-1/2

3)Tab.pan 40mg  PO/OD

4)Strict input /output charting

12/5/22

S- weakness,no pedal edema

O- patient is conscious, coherent, cooperative 

Vitals

Bp-100/60 mmhg

PR-86bpm

SpO2- 98%,@ RA

Temp-97.6F

CVS - S1,S2 +

RD - BAE +

A-Polycystic kidney disease with ? Hypothyroidism 

P-1)Inj optineuron1 ampoule + 100ml NS OD

2)Tab pan 40mg po/of

3)Tab pcm 650g po/tid

4)Tab telma 20 mg po/od

13/5/22

S- generalised weakness

O- patient is conscious, coherent, cooperative 

Vitals

Bp-100/70 mmhg

PR-84bpm

SpO2- 98%,@ RA

Temp-afebrile

CVS - S1,S2 +

RD - BAE +

A-Polycystic kidney disease with ? Hypothyroidism 

P-1)Inj optineuron1 ampoule + 100ml NS OD

2)Tab pan 40mg po/of

3)Tab pcm 650g po/tid

4)Tab telma 20 mg po/od

5) Tab ultarcet so

6)Tab Orofer XT po/od

14/5/22

S-lower backache

O- patient is conscious, coherent, cooperative 

Vitals

Bp-110/70 mmhg

PR-88bpm

SpO2- 98%,@ RA

Temp-afebrile

CVS - S1,S2 +

RD - BAE +

CNS- NAD

P/A -soft ,non tender

I/O-800/700

A-Polycystic kidney disease with ? Hypothyroidism 

P-1)Inj optineuron1 ampoule + 100ml NS OD

2)Tab pan 40mg po/of

3)Tab pcm 650g po/tid

4)Tab telma 20 mg po/od

5) Tab ultarcet sos

6)Tab Orofer XT po/od

7)Tab lasix 20mg stat

15/5/22

S-no complaints

O- patient is conscious, coherent, cooperative 

Vitals

Bp-110/60 mmhg

PR-84bpm

SpO2- 98%,@ RA

Temp-afebrile

CVS - S1,S2 +

RD - BAE +

CNS- NAD

P/A -soft ,non tender

I/O-1150/1200

A-Polycystic kidney disease with ? Hypothyroidism 

P-1)Inj optineuron1 ampoule + 100ml NS OD

2) Thyronorm 50mcg po/od

3)Tab pcm 650g po/tid

4)Tab telma 20 mg po/od

5) Tab ultarcet sos

6)Tab Orofer XT po/od

7)Tab pan 40mg po/od

16/5/22

S-no complaints

O- patient is conscious, coherent, cooperative 

Vitals

Bp-110/60 mmhg

PR-82bpm

RR-16cpm

SpO2- 98%,@ RA

Temp-afebrile

CVS - S1,S2 +

RD - BAE +

CNS- NAD

P/A -soft ,non tender

I/O- 1250/1200

A-Polycystic kidney disease with ? Hypothyroidism 

P-1)Inj optineuron1 ampoule + 100ml NS OD

2) Thyronorm 50mcg po/od

3)Tab pcm 650g po/tid

4)Tab telma 20 mg po/od

5) Tab ultarcet sos

6)Tab Orofer XT po/od

7)Tab pan 40mg po/od