E log book sravya busetty 32

General medicine case discussion

 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 icluding history,clinical findings,investigations and come up with a diagnosis and treatment plan.

You can find the entire real patient clinical problem in this link below.....(https://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.

A case of a 42 year old female patient with multiple health events since birth came to the department with cheif complaints of

1. Headache with aura
2. Swelling of face and abdomen 
3. Rash
4. Sleep disturbances 
5. Decreases frequency of urination

And the reason i found for the problems are:

1.headache:it is sudden in onset gradually progressive associated with aura and numbness on left side,stuttering of speech was there with vomiting

Probable diagnosis:

1.Hemiplegic migraine

2.Brain neuroplasms

3.transient ischaemic attacks

Probable investigations:

1.ct scan and mri of brain

2.EEG

3.Csf analysis

Treatment received till now:

Nattokinase,triptamines

Possible changes to the treatment:

Pharmacologically-to take antiemetics,antiepileptics for seizures 

Non pharmacologically-avoid triggering factors like stress and drugs

2.swelling:she's diagnosed as hemolytic anemia patient it is because of the G6PD deficiency it is because of the production of defective g6pd enzymes which cant generate NADPH which decreases the production of glutathione which is antioxidant resulting in increased rate of hemolysis resulting in increase of bilirubin and due to excess bilirubin kidney failure may occur giving rise to swelling.

Triggering factors are:consumption of fava bean,sulfa drugs and antimalarials 

Investigations done:

1.complete blood count-anaemia

2.heinz bodies in rbc

3.ecg-right heart enlargement

Investigations recommendations:

1.serum haptglobin which is reduced in g6pd deficiency 

2.peripheral blood smear

Treatment: she took cimetidine for reduction of swelling and also taken ribose to reduce fatigue which also helps in production of ATP

Treatment recommended:hydration and blood transfusions 

3.rash:she is also diagnosed as behcet's syndrome which is due to autoimmunity of the blood vessels leading to vasculitis resulting in rash

Triggered factors:stress

Recommended:skin prick test

4.sleep disturbances:it is due to deficiency of g6pd enzyme reslting in decreased formation of glycine

Treatment: L-serine acts like glycine and induces sleep 

5.oliguria:it may be due to oxidative stress occuring in G6PD deficiency which results in reduced NADPH and loss of ions causing decreased urination

Investigations recommended:

Urine examination

CT abdomen

Urine output

Treatment recommended:

Fluid intake

Diuretics

Currently she has rashes which are pressure on face development of swelling and has left jaw pain which radiates to face develops weakness on exertion and also diagnosed with behcet's disease