CASE DISCUSSION: A 42 YEAR OLD FEMALE WITH MULTIPLE HEALTH EVENTS

I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis with a treatment plan.

You can find the entire real patient clinical problem in the following link:

http://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.html#comment-form

CHIEF COMPLAINTS:

 

1.Swelling

2.Headache

3.Sleep deprivation

4.Decrease urine output

1.SWELLING:

-she developed swelling in face and abdomen at the age of 1 year. It was aggrevated by emotional stress; smoking; exercise; eating wrong food. Relieved on taking cimetidine.

Associated factors are dark coloured urine; breathing problems. 

DIFFERENTIAL DIAGNOSIS:

1. G6pd deficiency

2.kidney problems

3.cardiac problems

4.Angioedema

It might be due to G6pd deficiency because it maintain RBC membrane integrity. It generates NADPH and glutathione which are protective against oxidative stress. Lack of this lead to oxidative stress and produce free radicals and damage RBC and cause hemolysis.Hemolysis lead to breathing problems; rapid heart rate ; dark urine .

 INVESTIGATIONS: 

1.CBP- anemia

2.AST and ALT levels

3.Bilirubin levels

4.LDH levels

TREATMENT: 

1. control of foods and drugs causing swelling

2.cimetidine

2.HEADACHE:

 

She developed headache at the age of 2 years. It was gradually progessive. Aggrevated during menses.It was severely increased at the age of 15 that she could not come out of bed. Headache increased and aura was intensified to the point of not just obscurring colour  vision bit also getting full out of vision.It was associated with severe mood disorders; weakness on one side; stuttering of speech; nausea; vomiting

DIFFERENTIAL DIAGNOSIS: 

1. Hemiplegic migraine

2.cerebellar diorders 

INVESTIGATIONS: 

1. CT

2.MRI

TREATMENT:

Triptans

3.SLEEP DEPRIVATION:

It was since birth. 2 to r hrs of sleep. 

It could be due to G6pd deficiency leading to impairment in generation of glycine and serotonin production is decreased leading to sleep disturbance. It could be due to AMPDI deficiency.

Treatment:

She is on medication for serine.

4. DECREASED URINE OUTPUT: 

It could be due to G6pd deficiency leading to oxidative stress and resulting in decreased urine output.

Investigations: 

1. Urine examination.

2.ultra sound.

                                                        AKSHARA 84