1601006100-swarnamukhi

29YEAR OLD FEMALE WITH SOB, EDEMA,FACIAL PUFFINESS. PATIENT CAME TO CASUALITY WITH cheif complaints of - B/L PEDAL DEMA - 20 DAYS FACIAL PUFFINESS - 20 DAYS BREATHLESSNESS - 1 DAY  HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 10 YEARS BACK THEN WAS DIAGNOSED WITH DM-1 AND IS ON INSULIN MITARD (20U-X-16U).                 -SHE HAD 2 EPISODES OF WEAKNESS, UNCONTROLLED SUGARS FOR WHICH SHE WAS ADMITTED FOR A DAY &DISCHARGED ( 1ST EPISODE 5YEARS BACK AND 2ND EPISODE 3 YEARS BACK RESPECTIVELY).                                     -.ON NOV 2022 PATIENT WAS TAKEN TO GOVT HOSPITAL I/v/O SOB AND WAS DIAGNOSED WITH DENOVO HYPERTENSION, UNCONTROLLED SUGARS ( STARTED ON ? HTN MEDICATION).                            -.ON 2ND JAN 2023, SHE HAD EPISODES OF VOMITINGS, LOOSE STOOLS AND WAS ADMITTED IN AIIMS & WAS DIAGNOSED WITH   DIABETIC NEPHROPATHY, HTN ,VIT D DEFICIENCY .       Hyperpigmented lesion on right foot.                                                                      -6 DAYS BACK

March15,2023 50yr old male patient came to casuality with cheif complaints: Shortness of breath since -10days Swelling of upper and lower limbs since-6days Decreased urine output since - 6days HISTORY OF PRESENT IllNESS: -patient was apparently asymptomatic 1year back the he had SOB which is intermittent type and then he was also diagnosed with CKD 1year back -10days back he had sudden onset of SOB which is grade IV -orthopnea present -paroxysmal nocturnal dyspnea present -EDEMA of both upper and lower limbs . Lower limb edema which is Pitting type upto thigh  PAST HISTORY: -he was asymptomatic 10 years ago  -History of fall from tree then onwards he developed backache and neckpain .             -3yrs back he had fever ,cough,loss of appetite for 2months and had been diagnosed with tuberculosis and diabetes. -he took anti tuberculosis therapy for 6months and on oha since then. -Seasonal SOB with wheeze (since 3 years) on and off and with CKD 1 year ago.