A 65 yr old female with pedal edema and facial puffiness

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A 65 year old female came to opd with the chief complaints of fever since 20days ,pedal edema and facial puffiness from the following day

History of present illness

Patients was apparently asymptomatic 20days ago then she developed fever which is insidious in onset gradually progressive ,low grade fever, intermittent, Associated with body pains not associated with chills and rigors and weight loss

No history of nocturnal variation of fever

Patient when got fever 20days back she ignored it and went to work(farming) then she developed body pains which were insidious in onset gradually progressive they were unbearable for which she took a injection from local doctor and went for farming again, the following day morning she developed pedal edema and facial puffiness

Pedal edema was insidious in onset and it was pitting type below the knee

For which she went to a local hospital in miryalaguda they said to her she is having a kidney problem then she came to our hospital

Where she as being evaluated and initiated on hemodialysis

No history of decreased urine output

No history of burning micturition

No history of hematuria

No history of shortness of breath ,cough,palpitations , chest tightness, sweating

No history of weight-loss

No history of loss of consciousness,giddiness,involuntary passage of urine and stools

Past history

•She had Persistent cough 30years back for which she went to a hospital in mriyalaguda there she was diagnosed as tuberculosis they gave her ATT medication but she didn’t use them regularly (she only used for 3-4days)

•surgeries- tubectomy 35 years back after her 5th child

Cataract surgery for left eye 6years ago

Right eye 3years ago

•Not a know case of hypertension,diabetes,asthma,epilepsy,CAD,CVD

Family history-insignificant

Personal history

Diet-mixed

Appetite- normal

Bowel and bladder-regular

Sleep- adequate

Addictions-occasionally toddy

Daily routine

She wakes up at 4am , then complete her household work and have a cup of tea at 6am then packs herself breakfast leave for work(farming)by 8:30 -9:00am

At 12:30 she will complete her work and comes home have lunch and sleep for a hour and leave for work at 2:30pm and comes back by 5:00pm have dinner at 8:30pm and sleeps by 9-10 pm

Now as she is having pedal edema and generalised weakness she is unable to go for farming

And at that time she is sleeping or have chitchat with her grandchildren

General examination

Patient was conscious,coherent,cooperative

Moderately built and moderately nourished

There were no signs of pallor,icterus,cyanosis,clubbing,lymphadenopathy

Edema is present