76yrs/f h/o fall and Lt femur subtrochanteric fracture 5months back, she didn't take any treatment, bad ridden since 5months know diabetic &hypertensive, now pt disorientated last 2days, anasarca + dx, rx?

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This is a case of diabetes, hypertension,with old left femur subtrochanteric fracture and ,anasarca .,?. Glomerulonephritis and old anterior wall myocardial infarction Do the following investigations FPG PPG HBA1C CBP RFT LFT Micralbuminuria TFT serum electolytes serum proteins CUE Urine culture /sensitivity USG abdomen to r/o cirrhosis of liver,pyelonephritis, nephrotic syndrome, renal parenchymal disease, tumors ECG 2D ECHO The common causes of anasarca are Liver failure Kidney failure CCF Malnutrition Hypoproteinemia Gross Anemia In this case there is urinary tract infection Rule out hypoglycemia for disorientation Coming to the treatment Treat the underlying cause Give antibiotics according to culture and sensitivity report control diabetes and hypertension Give diuretics to reduce edema. supportive treatment

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contd This case needs a multi disciplinary approach and the team should consists of Endocrinologist Orthosurgeon Cardiologist General physician Intensivist

poor r wave progresion adv echo to rule out low ef..adv s magnesium it's acute confusional state..many conditions can cause it..it's common in old age patient above 60..even if patient has admitted with otherthan cns disorder 30 to 40 % old patient become delirius during hospitalization if all causes are ruled out we can treat them with olanzepine for short period and day light therapy

poor r wave progresion adv echo to rule out low ef..adv s magnesium it's acute confusional state..many conditions can cause it..it's common in old age patient above 60..even if patient has admitted with otherthan cns disorder 30 to 40 % old patient become delirius during hospitalization if all causes are ruled out we can treat them with olanzepine for short period and day light therapy

before doing all these investigations, just do x ray of hand with wrist and wrist with forearm ap and lateral view..sometimes many small fractures remain neglegted in such cases

U R absolutely correct form your angle, Totally agreed
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requires multidisciplinary approach. intensivist should take charge and co-ordinate all specialities. if patient recovers, mobilise as early as possible to fasten recovery.

Apt & Crispy answer dear
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As the pt is diabetic n hypertensive...see for kFT for diabetic n hypertensive nephropathy n urine routine for albuminuria that may cause generalised anasarca... As the Pt hv h/o fall with lt femur fracture...see for any chronic pulmonary embolism which may disturb cardiac function n may Leads to generalised anasarca...so get 2D Echo for ejection fraction n d-dimer levels ... If the swelling is only on hand and forearm with swelling n inflamed as shown in figure ..than may chances of forearm cellulitis...give antibiotic coverage for cellulitis..

Given the age and co morbids the patient is in altered sensorium which could be either due to hypertension ,or electrolyte abnormality if we look at the reports sodium is likely to the higher side ,with one value we cannot make the diagnosis ,another possibility is septic encephalopathy we need to do ct scan,urine spot sodium,urine osmolarity before doing other investigations so that reversible causes can be ruled out

Also rule out fat embolism

ecg show Low voltage in limb leads old Anterioseptal mi nothing acute in ecg

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