Amc bed 1
A 36 year old male patient who is a watchman in a govt. Hospital 1km far from home came to the casuality with swelling of the tongue and uvula.
Hopi:
Patient was apparently asymptomatic before 2007 and then he developed generalized swelling in the body (limbs followed by face) due to which he was admitted in a hospital in miryalguda where trachostomy was done and was referred to our hospital for further management.
Since then he had multiple episodes for which he took hydrocortisone and avil at home and if there was swelling in the face and throat he came to hospital.
Patient develop swellings when exposed to smoke/dust/when he eats certain foods (mutton,fish,brinjal,gongura).
Swellings usually appear 5 to 10 hours of exposure to triggers
Episodes are more in winters than in summers.
Patient was tracheostomised twice once in 2007 (had generalised edema) and 2016 (swelling of face and throat).
Patient is taking all precautions so he won't have an episode again but he is scared that he will have another episode as he has many triggers and his sleep is disturbed from an year.
Patient also gets the edema when he is stressed if they're any fights or loud voices.
Past history:
Not a k/c/o DM/HTN/TB/BA.
Family history:
No similar family history
O/e:
Patient is c/c/c
No signs of pallor or cyanosis or clubbing or icterus or koilonychia or lymphadenopathy.
Edema of the limbs -ve
Edema of the tongue and uvula present.
Vitals:
BP: 120/80
PR: 115
SPO2: 98@ RA
RS: BAE +
CVS: S1 S2 +
CNS: NFD.
Investigations:
Diagnosis:
Angio neurotic edema.
Treatment:
1. INJ. HYDROCORTIONE 100 MG IV BD
2. NEB with ADRENALINE QID
Treatment advice by ent department:
1. INJ. HYDROCORTIONE 100 MG IV QID
2. NEB with BUDECORT and ADRENALINE
3. Head end elevation.