59 year old male k/c/o T2DM on Glimiperide 1 +Metformin500mg presents with h/o b/l pedal edema which progressed to have puffiness of face and inturn abdominal distention. C/o breathlessness on exertion. No h/o chest pain, palpitations, fever,cough. No relevant past history PR-100bpm Bp-150/90 Spo2-96% at RA Systematic examination is wnl ? Anemia in failure

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Mediastinal widening with rt sided few bronchiectatic lesions seen. Anemia and hypoproteinemia needs to be treated. Evaluate and treat the active secondary infection.

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XRay chest- cardiomagaly,mediastinal widening,bronchiectatic lesions rt mid. ERYTHROIETIN Anaemia. needs further investigation kft,cbc, 24 hr urine protien, bsf,pp,hba1c,lft,urine r/m. nefrology consultation.

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? Iron deficiency anemia with cardiac failure Xray chest shows mediastinal widening with cardiomegaly . There is right paratracheal opacity. Need investigations for anemia, hypoprtoteinemia . ECHO, CT chest ,abdominal ultrasound

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look for RENAL FAILURE blood work up needs to be done patient is in volume overload plan for dialysis if required

Yes doctor this too is possible
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SUGGESTIVE. OF CHRONIC RENAL. FAILURE WITH C. H. F SECONDARY. TO DIABETES.. AND. H. T

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Hypoproliferative anaemia disorder with anasarca seems.. Find out the pathogenesis..primary and secondary cause by doing more investigation.. Find out abnormality with Thyroid/renal/cardiac/ liver functioning.. nutritional deficiency With sos bone marrow biopsy may be required.. More workup is required to do on this case.. Plz update with reports and kindly express complaints from how many days..

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pl add USG W/A,ECHO

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Anemia Nephrotic syndrome Erythropoietin deficiency Pleural effusion ... Treat underlying cause

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Microcytic anemia  Bilateral lung infiltrate  Edema.                           Look for diabetic Nephropathy                And cause of vol overload

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Thanks Dr Abira

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