A 37 year old male , a chronic alcoholic with severe shortness of breath and generalized edema
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Case
A 37 year old male came to the casualty with the chief complaints of shortness of breath since 6 days and generalised swelling of the body.
History of present illness
The patient was apparently a symptomatic 12 years back then he developed generalized swelling all over the body which was insidious in onset and gradually progressed up to 3 months and then he came to our hospital and he was referred to the higher Centre afterwards . when he was in our hospital there was a variation of the BP between the two arms and in the higher Centre he was treated for about a 6 to 7 days and then he became normal and he discharge. Afterwards for 3 months he didn't take any alcohol or any smoking after 3 months he again he started drinking alcohol smoking . Afterwards his having on and off episodes of edema , he was taking a tablet of lasilactone and the edema subsides after taking the tablet. 1 months back he is having this edema which doesn't subside after taking that tablet so he came to our hospital and gave a higher dose of lasix . From the past 5 to 6 days the edema wasn't subsided even after taking that higher dose of medication and he is having a shortness of breath from the past 4 days is not taking enough meals because he is having shortness of breath and distention of stomach while sitting and eating but he is having a good appetite but he is not able to eat .
On September 14th around morning from 1:00 a.m. he is having shortness of breath around 3:00 a.m. he is not able to take breath and came to our hospital
H/o dark colored stool since 4 day
H/o decreased urine output since 3 days
H/o dry cough ( sometimes only )
No h/o of fever ,
He is a chronic alcoholic since 2002
He takes alcohol almost daily about a half .
Last the consumption of alcohol was 20 days back ( according to his mother )
A chronic smoker takes 1 - 2 packs per day
Past history
Personal history
Diet mixed
Appetite normal
Sleep : disturbed : not able to sleep at night and sleeps in early mornings and day time .
Bowel : dark colored stools since 4 days
Bladder : decreased in amount and frequency
Addictions : a chronic alcoholic since 20 years and nearly for 8 years he consumed daily about ≈ 15 units of alcohol
A chronic smoker : 1 - 2 packs per day
Family history
General physical examination
Pallor: absent
Icterus: yellowish discoloration of sclera-present
Cyanosis-absent
Clubbing-present
Lymphadenopathy:absent
Edema- generalised edema is present
Vitals
Temp 98.6°F
PR :
RR
BP
Pitting edema on shin of tibia
Systemic examination:
CVS:
Inspection:
Pericordial pulsations visible (vaguely)
Palpation:
Apex beat felt in 6th intercostal space, 10cm from sternum
Parasternal haeves,thrills are felt.
Percussion:
Auscultation:
GIT:
?Abdomen distension,soft and non tender
?shifting dullness
?Hepatomegaly
Respiratory:
CNS: No focal neurological deficits present
Investigations
Treatment:
INJ . LASIX 40mg / IV/TID
SALT RESTRICTION<2g/ day
FLUID RESTRICTION <1L/day
TAB MET-XL 2mg/PO/OD
INJ THIAMINE 200 mg in 100 ml NS IV/ TID
BP/PR/RR/ SpO2 charting 2hrly
Day 2
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