A 25yr old female with history of generalized edema and shortness of breath.

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box.


Chief complaints : 


Bilateral pedal edema on and off since 1 month.

Shortness of breath since 2 days.

Fever since 4 days.

History of present 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 @ 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 : 


K/C/O Hypertension since 20 days ( on Tab.Nicardia 20mg BD ).


Not a known case of Diabetes, TB, CAD.


Personal history -


Appetite - normal 


Diet - mixed


Bowel - regular


Micturition - burning micturition


No known allergies.


Addictions - None present



Family history : no significant family history


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% @ RA


 GRBS- 100mg /dl


Per Abdomen:

Scaphoid

Bowel sounds heard


Cardiovascular system :

S1 S2 heard 

no cardiac Murmurs


Respirator system :

Trachea position Central 

Vesicular breath sounds


CNS:

No focal and neurological deficits.






Investigations... 




ECG 


Radiology: 


Chest Xray - Normal


Report.... 


Provisional diagnosis - 

HELLP Syndrome... 

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