66year old female with chronic heart failure with severe anaemia

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Case:

A 66 years old female came with complaints of loose stools,vomitings,and pain abdomen since 1month

Decreased urine output since yesterday which was relieved by taking tab lasix.

patient had recurrent hypoglycemic episodes since 1month about 3episodes.

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 1month back and later developed loose stools 3-4episodes per day since then and subsided when taken medication.

history of nausea and vomiting from 1month.

pain abdomen from 1month on and off.

Patient is a known case of hypertension on telmisartan 40mg

This Hypertension was detected when patient felt headache and postural giddiness while standing suddenly and went to local hospital for further checkup and diagnosed with hypertension.

A known case of diabetic on tablet metformin 500mg.

This diabetes was detected 10years back when she felt giddiness and went to local hospital for checkup and diagnosed with type 2 diabetes mellitus.

HISTORY OF PAST ILLNESS:

There is no history of EPILEPSY/ASTHMA.

Dental fixature in situ.

PATIENT DAILY ROUTINE.

She is a 67 year old, widow, homemaker by occupation living with his son and daughter-in-law presented with complaints of nausea and persistent vomiting and diarrhoea since 3 months worsening since 1 month

She was apparently alright 11 years back on doing her daily household chores had an episode of giddiness and was taken to a local hospital, managed symptomatically was also diagnosed with diabetic and hypertension and was on regular medication

She has given multiple episodes of giddiness 5 years back and asking her to describe the events She remembers the whole incident and she has to sit and take the medication prescribed earlier and were relieved after around 10-15 mins, sometimes she has to lie down in order for her symptoms to be relieved

On further probing she describes it as plain blank vision ( dark ) and resumes to normal after lying down or sitting with recurrence one year back too

3 years back she first had an episode of shortness of breath and on and off since then

And was also admitted in our hospital 1 year back with no history of pedal oedema or decreased urine output, frothy urine hematuria

She’s been in iron supplementation since two years and she herself describes passing black coloured stools as iron causes it ( insight !! ) and was also diagnosed to be having anemia on one the episodes of giddiness as was adimitted on private hospital

2 years back bcz of recurrent head aches she got an ?CT or MRI done and was told she has a blood clot and was prescribed blood thinners and later stopped after a while and continued using only statins ( cholesterol goli )

2 years back she had fixation of dentures and her problem started after one year of fixing with and consulted the respective doctor and was advised soft diet

Dietary history

She had good appetite prior to one year back

Usual routine includes 3-4 idly/ dosa / Upma for break fast followed by rice with dal and sambar and same cuisine for the night which gradually decreased to 1 idly or no food as she lost her appetite and repeated vomiting and diarrhoea episodes which was from 3-4 months

On elaborate the present complaints

Her appetite Worsened since the past 3 months with nausea and vomiting as a reflux with food as content and multiple episodes of diarrhoea with 3-4 episodes in each session ( Morning, afternoon and night ) watery stools, large volume and dark not associated with mucus, blood, flatulence and has pain abdomen before passing stools around the umbilical region and relieved after defecation which was from around 1 month m

Since 10-20 days her appetite decreased to only liquids which was first followed by solids and later to liquids

She lives with her son ( total 3, 2 daughters and 1 son ( eldest ) ) who resides at champapet, widow ( husband a chronic smoker and had died bcz of ? Smoking and h/o usage of biofuel for the past 25 years.

DIETERY ROUTINE

Patient is a housewife by occupation since 40years.

Patients day starts with a glass of buttermilk early morning and after 1hour breakfast with bread and milk.

Rice mixed with buttermilk in the afternoon.

Sleep for 2hours and at 4pm again bread and milk as snack.

By 8:30pm Rice mixed with Buttermilk as dinner and used to sleep by 10pm.

no other household activities in between.

This routine started since 10years after dental fixature and continued till 1month back and then gradually her appetite decreased.

She then started developing above mentioned complaints.

Treatment history:Patient was on medication as follows

1.Tab METFORMIN 500MG od

2.T. TELMISARTAN 40MG OD