35 F with nephrotic syndrome
35 year old female P2L2A1 presented to casualty with complaints of : Pedal edema since 6 months Sob since 6 months- grade 1 initially progressed to grade 4 . Loss of appetite since 6 months Fatigue since 6 months Generalized anasarca since 3 months . Timeline of events : Past history - Not a k/c/o CAD ,CVA ,TB , Epilepsy . On presentation her vitals : Bp -160/100 mmhg Pulse rate - 108 bpm,regular normal volume ,no radio radial delay . RR - 28/min. Spo2- 88% On RA and with 6 lit oxygen 94% Grbs -125 mg/dl Temp -99.4 F GENERAL EXAMINATION : Pt C/C/C Pallor - present No icterus , clubbing, cyanosis,koilonychia , lymphadenopathy . B/L pedal edema - pitting type present. Generalized anasarca noted Jvp - elevated Skin - Dry ,scaly , itching present . Hyperpigmented skin lesions noted on hands ,over chest wall and over knee and shin of both legs . SYSTEMIC EXAMINATION : Cvs - S1S2 present RS - B/L diffuse crepitations heard in all areas . CNS - No FND . INVESTIGATIONS: PER