Swelling over the Face & Legs

Chief complaint A 63 y/o female came with swelling over the face and legs with mild chest pain, productive cough and breathlessness. History She has h/o asthma and on medication for the same. No complaint of fever. She is a chronic smoker, smokes 3 cigerrates/day and drinks occasionally. Vitals BP: 130/80 mmhg, Resp rate: 18/min, HR: 81 bpm Physical Examination She is mildely obese woman. Pitting edema was noted on both the legs. Rest of the exam was normal. Investigations Chest x ray shows bilateral pleural effusion. Calcifications were also noted. Management Please give your opinion.

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? CARDIAC PATHOLOGY .. ? RENAL PATHOLOGY .. ? ANEMIA WITH .. HYPOPROTEINEMIA .. ? HORMONAL ..

D/D Hypothyroidism Hypoproteinemia Renal disorder Liver disease R/O Tuberculosis

Anemic Renal disease Bacterial infection in chest Needs Sugar test CBC test Lipid profile Renal analysis Urine culture test Symptomatic T/T clinical correlation

Needs blood for TC, DC, ESR, HB%, CRP, LET, BS(F), PP, UREA CREATININE, SODIUM POTASSIUM , T3, T4, TSH. Urine RE, ME, C&S. HRCT THORAX AND COVID 19 WITH RTPCR.

Can be CCF Renal failure- acute/chronic/ acute on chronic Hypoproteinemia Hypothyroidism

Bilateral plural effusion With oedema feet Facial swelling Ccf Usg tapping cbnat

Possibly transudate. Evaluate considering various etiologies.

Adv X Ray chest ECG, 2 D Echo, CBC, LFT, Total protein and albumin, urine routine and culture

Cor pulmonale

Take an ecg.... It can be pulmonary edema with heart failure(Right heart failure).... In such cases give inj Deriphilline, Bednesol and Nebulise with duolin + budecort. Lasix injection should also be given to improve the condition but have an electrolyte check particulary pottassium nd sodium.... Actually there can be no chance of RR 18/min if she is breathless, Recheck bp and PR ABG should be done Ecg to exclude pulmonary edema and Rt heart failure Se electrolytes to exclude Hyperkalemia and hyponatremia Check for PR interval in ecg if its long with almost flattened P waves it can be hyperkalemia TSH and Free T3&T4 should also be evaluated Complete blood count, esr, crp

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