A 34 years Male Patient With Chest Pain and Pedal edema.

THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT 
CHEIF COMPLAINTS:-
Chest pain in epigastric region since 1week.
Pedal edema since 1week .
Cough with expectoration since 1week .(mucoid consistency,non blood stained, non foul smelling)
Decreased urine output since 1week. 
HISTORY OF PRESENT ILLNESS :-

Daily routine of the patient :

The patient used to get up at around 7/8 in the morning, used to have breakfast  (Rice) and then used to go to drive auto. He then returns home in the evening and then used to consume alcohol daily before eating which was around 180ml and then sleep at around midnight at around 1/2. 

His intake of alcohol has increased to 750 ml per day (which is due to family issues according to the patient) and stopped consuming food at night.

4 years back he started noticing swelling in his hind limbs and he couldn't walk properly and experienced tingling sensation in fingers and went to hospital where doctors did a lumbar puncture and collected CSF and said there is accumulation of fluid over there.They gave them medications and patient continued to take medicines for 5 months and later he stopped taking them. After this he again started having alcohol and lost appetite ,had no proper food

Eventually the distension and swelling subsided and the patient started drinking again.

HISTORY OF PAST ILLNESS :-
H/O  Pulmonary Tuberculosis 7yrs back.
No H/O Hypertension, Diabetes mellitus, Asthma, CAD,CVA.
Patient lost his consciousness ,fainted 5 years back and came to emergency  where cpr is done
PERSONAL HISTORY:-
Married 
Occupation-Auto Driver 
Appetite-normal 
Diet-nonvegeterian
Bowels-regular 
Micturition- abnormal 
No known allergies 
Addictions- non smoker,Alcoholic 
FAMILY HISTORY:-
no significant family history 
GENERAL EXAMINATION:-
no pallor, cyanosis, icterus, lymphadenopathy, clubbing of fingers or toes,  malnutrition,
dehydration.
VITALS:-
Temp- afebrile 
Pr- 84/min
Rr-22/ min
Bp-120/90 mm /Hg
Spo2- 98%
SYSTEMIC EXAMINATION:-

a)CVS - S1 S2 Positive 
b)Respiratory system  -BAE Positive 
c)Abdomen-soft, non tender,no palpable mass
d)CNS
    consciousness
    Speech- normal 
     Signs of meningeal irritation like neck           
      Stiffness, kerning 's sign- no
     Cranial system, motor system, sensory 
     system- normal.
 e)  no cerebral signs
INVESTIGATIONS:-

TREATMENT:-
Inj- Lasix-40mg/IV/BD
Inj- Thiamine-200mg in 100ml NS/IV/TID
Inj- Pan-40mg/IV/OD
Inj- Optineuron 1amp in 100ml NS/IV/OD
NEB with Duoline,Budecort,Mucomist 8th hourly
Syp- Grillinctus BM 10ml/PO/TID
Fluid restriction <2l
Salt restriction <4GM/DL
BP ,PR, SPO2 monitoring 6th hourly 
Tab-pulmocler PO/BD



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