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202104460


40/M, LORRY DRIVER CAME WITH C/O
PEDAL EDEMA SINCE 5-6DAYS
ABDOMINAL DISTENTION SINCE 5-6 DAYS COUGH SINCE 5-6 DAYS
SHORTNESS  OF BREATH ON WALKING FOR LONG DISTANCES NYHA GRADE 2 TO GRADE 4ABLE TO CLIMB 2 PLIGHT OF STAIRS, ON LIFTING WEIGHTS, PROGRESSED TO ORTHOPNEA IN 1 WEEK 
PEDAL EDEMA DECREASING WITH LIMB ELEVATION 
COUGH SINCE 6 DAYS ASSOCIATED WITH  SPUTUM SMALL AMOUNTS, WHITE COLOUR, NON FOUL SMELLING , NOT ASSOCIATED WITH BLOOD , NO COLD, NO FEVER ,NO WHEEZE,
NO CHEST PAIN,NO PALPITATIONS , NO SYNCOPAL ATTACKS
H/O HOSPITALIZATION FOR  RIGHT HEART FAILURE- WET BERI BERI 1 YEAR BACK
8 MONTHS BACK ADMITTED  IN OUR HOSPITAL  WITH  AIDP/?DRY BERI BERI 
KNOWN  ALCOHOLIC SINCE7 YEARS TAKES 360 ml/day  3-4 TIMES  A WEEK
C/O CONSTIPATION SINCE 1 MONTH 
HIS FATHER IS KNOWN DM+

PATIENT  IS CONSCIOUS COHERENT COOPERATIVE 
BP-140/90mmHg
PR-94 BPM 
RR -24CPM
SPO2-98 AT RA
GRBS -90mg/dl
WEIGHT -72KG
O/E 
B/L PEDAL EDEMA +
 NO PALLOR, NO ICTERUS ,NO CYANOSIS, NO CLUBBING, NO LYMPHADENOPATHY 

CVS-S1S2 + , LOUD S1 + IN TRICUSPID AREA, RAISED  JVP +



RESP- DYSPNEA GRADE II TO IV,  ORTHOPNEA +

ABDOMEN - SOFT, TENDERNESS IN RIGHT ILIAC REGION 

CNS :
Tone-  normal 
Power :-  upper limb
                 RT      LT
                 5/5     5/5
Reflexes :- RT.      Lt
        B.        +         +
        T.        +          +
        S.        +          +
        K.         -           -
        A.         -          -
      Plantar.  F.       F




INVESTIGATION :
USG
LFT:
RFT
CUE
CXR
2D echo 

PROV. DIAGNOSIS :
? WET BERI-BERI 
RIGHT HEART FAILURE 
? ALCOHOL FATTY LIVER DISEASE
K/C/O HYPOTHYROIDISM 

TREATMENT: 
1. FLUID RESTRICTION <1.5Lt/DAY
2. SALT RESTRICTION <2 GRAMS/DAY
3. INJ. THIAMINE 1 AMP IN 100ml NS/IV/TID
4. TAB. LASIX 40 mg/po/BD
5. TAB.  THYRONORM 25 mcg/po/OD
6. BP CHARTING 8TH HOURLY 
7. TAB.  ULTRACET PO/BD


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