medicine case study

Present condition 
The patient.. falls frequently to the left. Her left foot and hand started to worsen. She has  Rashes on face around 2 to 4 episodes per year . Developed swelling, hair loss and fatigue. She has left jaw pain radiating to the face. She has dyspnea, oliguria .develops swelling when ingesting most of the foods, or smoke.Finds herself to be slim morning and appears to be a pregnant in the noon.  Develops weakness on exertion. Craves for salt . Ingests 2-4 tbs of salt when she feels sick. 

EVALUATION OF THE SYMPTOMS:
Swelling and breathing difficulties:
-swelling which is the main complaint can be due to her having g6pd deficiency which causes hemolysis n in turn causes congestive heart failure nd shortness of breath. She might have developed kidney failure leading to the swelling due to the oxidative stress...g6pd is an enzyme that catalyzes the rate limiting step in penrose phosphate pathway n produces NADPH which in turn produces glutathione that prevents oxidative stress 
 Investigations:
Complete blood count -anemia 
Ast and alt -increased 
Chest-x-ray-left atrial enlargement
Ecg -right heart enlargement
Echocardiography
Treatment:
She's given cimetidine that reduced her swelling

 
Loss of coordination and migraine:
she has low vitamin B12 levels which causes demyelination of neurons ,may be a cause for loss of coordination and spinnimg movementsThe exact cause of migraine is to be evaluated. It is associated with Aura and left sided numbness , mild memory loss, stuttering of speech and nausea and vomiting. The patient might be having some brain infections or tumors that may cause the left side numbness 
Treatment:
Nattokinase was given which improved her symptoms 


Rash:
Since she's diagnosed as behcets syndrome patient there might be autoimmune response to the blood vessels leading to the vasculitis nd development of rash n blurred vision nd it also might be the cause of failed LASIK surgery 

Oligouria:
It maybe due to the oxidative stress n loss of ions in the g6pd deficiency leading to the decreased urination in the patient or due to some infections 
Investigations:
Urine output 
Urine examination
Ultrasound /CT abdomen
Blood tests 
Cystoscopy
Treatment:
Ask the patient to take more fluids n antibiotics in case of infection

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