25 YEAR OLD FEMALE WITH SOB,FEVER,B/L PEDAL EDEMA

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CHEIF COMPLAINTS:

B/l pedal edema since 1 month on and off

Fever since 4 days

Sob since 2 days

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 1 month back (G2P1L1 at 30 weeks of gestation) when she developed generalized edema for which she visited local hospital and was diagnosed with gestational hypertension and started on Tab.Labet 100 mg. After 1 week she developed 2 episodes of seizures (tongue bite - present, LOC - present) for which she went to Yashoda hospital.

MRI brain was done which showed PRES (Posterior reversible encephalopathy syndrome) and Emergency LSCS was done on 10/10/22 at  30 weeks of gestation i.v.o fetal distress. Patient developed 1 episode of seizure in OT and was kept on mechanical ventilation support and was extubated after 1 day. Patient was started on IV antihypertensives, IV antiepileptics, blood transfusion, lasix. After 1 day, patient was discharged on LAMA from Yashoda. Patient was taken to local hospital and i.v.o deranged RFT and LFT 3 sessions of hemodialysis was done.

Now since 2 days patient is having shortness of breath Grade 2, insidious in onset, aggrevated on lying down and not associated with chest pain or cough. Fever, high grade not associated with chills or rigors relieved on medication associated with burning micturition.

PAST HISTORY:

Hypertension since 20 days

Not a known case of DM,TB,CAD,asthma,thyroid disorders

PERSONAL HISTORY:

Appetite - normal 

Diet - mixed

Bowel and bladder- regular

Micturition - burning micturition

Allergy: no known allergy present

Addictions - None present

FAMILY HISTORY:not significant

GENERAL EXAMINATION:

Patient is conscious, coherent and cooperative .

Well built and nourished

No Pallor ,icterus, cyanosis, clubbing,lymphadenopathy, Edema.

Vitals:

Temperature -afebrile

Pulse rate- 123 bpm

BP-180/120 mmHg

SPO2-94% 

 GRBS- 100mg /dl

CVS:

S1,S2 heard

No murmurs are present

RS :

On inspection ‐

• Chest is bilaterally symmetrical 

• Expansion of chest: Equal on both sides

• Position of trachea: Central

• No visible scars, sinuses, pulsations

On palpation : 

• Expansion of chest was equal on both sides. 

• Position of trachea: Central

• Tactile Vocal Fremitus: resonant note was felt.

On percussion: all lung areas were resonant 

On auscultation : 

• Bilateral air entry was present, normal vesicular breath sounds were heard. 

• Vocal resonance: resonant in all areas

P/A : soft, non tender, no organomegaly, no distension,  bowel sounds heard.

CNS : The patient is well oriented to time, place, person.

Higher mental functions are intact.

Cranial nerve examination :‐

All cranial nerves are intact and functioning. 

Motor System Examination :‐

• Normal bulk in upper and lower limbs

• Normal tone in upper and lower limbs

• Normal power in upper and lower limbs

• Gait is normal 

. Reflexes are normal .

Sensory System Examination :‐

Normal sensations are felt in all the dermatomes.

No cerebellar signs .

No meningeal signs.

INVESTIGATIONS:

RFT:

LFT:

CUE:

USG:

PROVISIONAL DIAGNOSIS :

Hellp syndrome

MAHA