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80F HFmEF ; CAD ; DM ; HTN

 Diagnosis ACUTE PULMONARY EDEMA (RESOLVED) SECONDARY TO HFMEF WITH CAD PRERENAL AKI DIABETIS TYPE II HYPERTENSION Case History and Clinical Findings PATIENT CAME WITH CHIEF COMPLAINTS OF DIFFICULTY IN BREATHING SINCE LAST NIGHT. HOPI - PATIENT WAS APPARENTLY ASYMPTOMATIC 18 MONTHS BACK THEN SHE DEVELOPED DIFFICULTY IN BREATHING WITH SWELLING OF B/L LOWER LIMBS WITH FACIAL PUFFINESS AND WAS HOSPITALIZED AND TREATED. C/O DIFFICULTY IN BREATHING SINCE 1 AM LAST NIGHT (GRADE 4 MMRC). C/O CHEST PAIN - DIFFUSE ORTHOPNOEA PRESENT, H/O PND PRESENT NO H/O FEVER, SEIZURES, VOMITING, LOSS OF CONSCIOUSNESS, PALPITATIONS, GIDDINESS, SWEATING, COUGH, COLD. NO C/O DECREASED URINE OUTPUT, FACIAL PUFFINESS, ABDOMINAL DISTENSION. PAST HISTORY: K/C/O HTN SINCE 45 YEARS USING T.OLMESARTAN 20MG BD. K/C/O DM SINCE 12 YEARS USING T.METFORMIN 500MG BD K/C/O CAD SINCE 1.5 YEAR USING CLOPIDOGREL 75MG BD NOT A K/C/O EPILEPSY,TB, ASTHMA. GENERAL EXAMINATION : PT IS CONCIOUS , COHERENT AND COOPERATIVE , MODERATLY
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14F DKA ; T1DM Since 3 Years

Case History and Clinical Findings C/O SOB SINCE 2 HRS FEVER SINCE 8 HRS RASH OVER THE ABDOMEN SINCE 3 DAYS PATIENT WAS APPARENTLY ASYMPTOMATIC 2 HRS BACK THEN SHE DEVELOPED SUDDEN ONSET SOB GRADE 4 NO ORTHOPNEA/PND ,CHEST PAIN,PALPITATIONS,PEDAL EDEMA ,EXCESSIVE SEATING,GIDDINESS,WHEEZE PT IS K/C/O TYPE 1 DM ,MISSED 2 DOSES OF INSULIN 1 EP OF FEVER HIOGH GRADE A/W CHILLS AND RIGORS RASH OVER THE ABDOMEN SINCE 3 DAYS INITIALLY SMLL IN SIZE LATER PROGRESSED TO CURRENT STATE .H/O APPLYING PCM PASTE TO LESION NO H/O VOMITING,LOOSE STOOLS ,PAIN ABDOMEN,GIDDINESS PAST HISTORY : K/C/O TYPE 1 DM SINCE 3 YRS ON NPH,HAI INSULIN H/O RT HUMERUS FRACTURE ,TREATED CONSERVATIVELY NOT K/C/O HTN,ASTHMA,TB O/E PATIENT IS CONSCIOUS,COHERENT,COOPERATIVE NO SIGNS OF PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,PEDAL EDEMA VITALS ; TEMP-98.8 BP-110/60 MMHG PR-158 BPM GRBS-HIGH SPO2-98 ON RA CVS :S1,S2 HEARD,NO MURMURS RS:BAE +,NVBS CNS: NAD P/A :SOFT,NON TENDER ,BOWEL SOUNDS+ DERAMTOLOGY REFERRAL DONE
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46M Uncontrolled DM ; ADS ; TDS

  Case History and Clinical Findings C/O SPASM OF FINGERS OF UPPER LIMBS WITH TREMORS SINCE 3DAYS ,EXCESSIVE SWEATING AND GENERALIZED WEAKNESS SINCE 3DAYS . PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS BACK ,THEN HE STARTED BINGE DRINKING AND SINCE 3DAYS HE DEVELOPED SPASM OF FINGERS OF UPPER LIMB WITH TREMORS . H/O SWEATING PRESENT . H/O ANXIETY IS PRESENT . NO H/O CHEST PAIN AND PALPITATIONS , ORTHOPNEA,PND NO H/O VOMITINGS,ABDOMINAL PAIN ,DIARRHEA . H/O COUGH WITH EXPECTORATION ,WHITISH IN COLOR SINCE 10 DAYS INCREASED IN SUPINE POSITION . K/C/O TOBACCO DEPENDENCY SYNDROME K/C/O DM 2 SINCE 6 YRS NOT A K/C/O HTN,CVA,CAD,TB,EPILEPSY . H/O 2 UNITS OF BLOOD TRANSFUSION H/O SURGERY FOR PANCREATITIS PERSONAL HISTORY APPETITE LOST SINCE 10 DAYS DIET MIXED BOWEL AND BLADDER REGULAR OCCASSIONAL ALCOHOLIC SMOKING TOBACCO SINCE 15 YRS WITH 10 CIGGARETES PER DAY GENERAL EXAMINATION PT IS CONSCIOUS,COHERENT ,CO OPERATIVE NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHADENOPATHY,OEDEMA VITALS TEMP : 99
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57M DKA ; Chr.Pancreatitis; CKD ; DM ; HTN

  Case History and Clinical Findings C/O ALTERED SENSORIUM SINCE 6 DAYS. PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS BACK THEN HE STOPPED USING INJECTION MIXTARD SC/BD SINCE 3 DAYS.H/O OF IRRELEVANT TALK SINCE YESTERDAY BUT ABLE TO RECOGNISE ATTENDERS.PATIENT IS ABLE TO MOVE ALL LIMBS AND NO H/O INVOLUNTARY MOVEMENTS. H/O LOW GRADE FEVER SINCE 6 DAYS,INTERMITTENT IN NATURE,TEMPORARILY RELIEVED ON MEDICATION. NOT A/O WITH BURNING MICTURITION,COLD, COUGH,VOMITING,LOOSESTOOLS. NO C/O SOB,CHESTPAIN,PALPITATIONS,ORTHOPNRA,PND,PEDAL EDEMA OR DECREASED URINE OUTPUT. PAST H/O: H/O SIMILAR COMPLAINTS IN FEB 2022,PATIENT WAS ADMITTED IN OUR HOSPITAL AND WAS DIAGNOSED AS HHS WITH DIABETIC NEPHROPATHY. PATIENT HAD H/O HIGH GRADE FEVER WITH CHILLS FOR 4 DAYS AND H/O STOPPAGE OF OHAS FOR 3 DAYS. K/C/O DM2 SINCE 1.5 YEARS. K/C/O CHRONIC PANCREATITIS AND CHRONIC KIDNEY DISEASE SINCE 1 YEAR H/O PULMONARY TB 2 YEARS AGO,USED ATT FOR 6 MONTHS GENERAL EXAMINATION: PATIENT IS CONSIOUS NOT ORIENTED TO TIME ,
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35M DCLD ; ACD ; DM

  Case History and Clinical Findings PATIENT CAME WITH C/O DISTENSION OF ABDOMEN SINCE 3 MONTHS C/O SHORTNESS OF BREATH SINCE 3 MONTHS C/O PEDAL EDEMA SINCE 20 DAYS HOPI: PATIENT WAS APPARENTLY ASYMPTOMATIC 3MONTHS BACK THEN DEVELOPED DISTENSION OF ABDOMEN WITH SHORTNESS OF BREATH , GRADE II , INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE , NO AGGREVATING AND RELIEVING FACTORS . C/O PEDAL EDEMA SINCE 20 DAYS, B/L PITTING TYPE , EXTENDING UPTO THE KNEE C/O DECREASED IN URINE OUTPUT SINCE 20 DAYS C/O FEVER SINCE 5 DAYS ON AND OFF, ASSOCIATED WITH CHILLS AND RIGORSNO C/O ORTHOPNEA ,PND , CHEST PAIN NO C/O ORTHOPNEA , PND, CHESTPAIN ,PALPITATIONS NO C/O PAIN ABDOMEN , VOMITINGS ,LOOSE STOOLS PAST HISTORY: K/C/O CLD K/C/O T2DM SINCE 6 MONTHS AND IS ON UNKNOWN MEDICATION H/O ALBUMIN TRASFUSION DONE N/K/C/O HTN, EPILEPSY, ASTHMA, THYROID DISORDERS PERSONAL HISTORY : DIET :MIXED APPETITE :DECREASED SLEEP: DISTURBED H/O ALCOHOL INTAKE SINCE 20 YEARS EVERY DAY ABOUT -50ML NO H/O TOBACCO INTAKE NO H
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75M DCLD ; HFpEF ; HCC ; DM

  C/O ABDOMINAL DISTENSION SINCE 1WEEK  C/O DECREASED APETTITE SINCE 1 WEEK  C/O DECREASED URINE OUTPUT SINCE AFTERNOON  PT WAS APPARENTLY ALRIGHT 1MONTH BACK THEN HE DEVELOPED PAIN ABDOMEN ON AND OFF , THEN HE DEVELOPED ABDOMINAL DISTENSION , WHICH WAS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE . NO H/O FEVER , NAUSEA , VOMITING ,LOOSE STOOLOS , CONSTIPATION HE HAD LOSS OF APPETITE SINCE 1 WEEK AND DECREASE IN URINE OUTPUT SINCE AFTERNOON. NOT A K/C/O DM ,HTN , ASTHMA , TB , CAD , CVA , EPILEPSY OCCASIONAL ALCOHOL INTAKE , NO H/O SMOKING .  GENERAL EXAMINATION : PT IS C/C/C, MODERATELY BUILT AND NOURISHED  NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMHADENOPATHY , EDEMA AFEBRILE  PR -120BPM  BP - 130/80 MMHG  RR - 20CPM  SPO2 - 98% AT ROOM AIR  GRBS - 108MG%  CVS - S1S2 HEARD , NO MURMURS  CNS-HMF INTACT . NFND  RS -BAE PRESENT , NO ADDED SOUNDS  P/A - ABDOMEN DISTENDED , UMBILICUS CENTRAL , FLANKS FULL , NO ORGANOMEGALY , SHIFTING DULLNESS PRESENT , FLUID THRILL
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14F DKA ; T1DM Since 4Y

  Case History and Clinical Findings PATIENT CAME TO THE CASUALTY WITH CHIEF COMPLAINTS OF: 1. SHORTNESS OF BREATH SINCE 2 DAYS 2. FEVER SINCE 1 DAY 3. ABDOMINAL PAIN SINCE 1 DAY 4. VOMITING 1 EPISODE HOPI: THE PATIENT WAS APPARENTLY ASYMPTOMATIC 4 YEARS AGO, THEN SHE HAD A FEVER WITH GENERALISED BODY WEAKNESS AND POLYURIA AND WAS DIAGNOSED HAVING TYPE 1 DM AND STARTED ON INSULIN. 2 YEARS AGO PATIENT HAD SIMILAR COMPLAINTS AFTER AN EPISODE PF FEVER AND WAS ADMITTED AT OUR HOSPITAL AND WAS TREATED HERE. 2 DAYS AGO SHE DEVELOPED SUDDEN ONSET SHORTNEESS OF BREATH SINCE 2 DAYS, GRADUALLY PROGRESSIVE AND PROGRESSED TO STAGE 4. SHORTNESS OF BREATH STARTED AFTER PATIENT MISSED TAKING 2 DOSES OF INSULIN. NO ORTHOPNEA, NO PND. FEVER SINCE 1 DAY, HIGH GRADE ASOCIATED WITH CHILLS AND RIGORS, RELIEVED ON TAKING MEDICATION, NO DIURNAL VARIATION. ABDOMINAL PAIN SINCE 1 DAY IN EPIGASTRIC REGION, LATER PROGRESSED TO DIFFUSE ABDOMINAL PAIN, NO H/O VOMITING, LOOSE STOOLS, GIDDINESS. HEADACHE PRESENT, VO
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