Medicine case

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Hi everyone, this is 4th year mbbs student and i was given a case to learn better in approaching a case.
Case given to me is in the link given below:
https://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.html?m=1

Case:
It was a 42yr old female with problems:
1.Loss of coordination ,numbness on the left side.
2.Breathing problems.
3.Salt cravings.
4.Swelling.
5.Poor stress response.


Reasons for the problems:

1.Loss of coordination and numbness on the left side indicating like left sided hemiplegia.
-causes can be Brain infections,Brain tumors,Genetic abnormalities.
-she also suffered with very long duration of migraine and severe headache;hemiplegia associated with migraine can be hemiplegic migraine which is a genetic abnormality due to mutation of genes like ATP1A2,SCN1A.
-she has low vitamin B12 levels which causes demyelination of neurons ,may be a cause for loss of coordination and spinnimg movements.

2.Breathing problems:
-she is suffering with G6PD deficiency.Glucose 6phosphate dehydrogenase enzyme which is required in the generation of ROS(reactive oxygen species) like peroxides,superoxides in macrophages required fpr killing the bacteria .Due to the deficincy ,there is weak immunesystem and results in severe infections which resulted in chronic lung infections and liver infections.
Due to which she has chronic beathing problems.

3.Salt Cravings:
-she would like to take excess salt which may be related to conditions like electrolyte imbalance as she was even associated with severe headache,nausea and vomitings.
-Addisons disease and stress.
-As she is using NAC tab 600mg for the COPD ,which has the side effects like nausea and vomiting.
-she is also using the Cimetidine 400mg,used treat ulcers of stomach and intestine is a H2 receptor blocker has anti androgenic effect and may cause salt cravings and which may even be the cause of poor stress respose.

4.Swelling:
-swelling which is the main complaint can be due to her harmonal changes,inflammation of blood vessels,infections( h/o of kidney infections).
-even associated with mouth ulcers,
-too much salt intake may also be a cause.

Investigations:
-complete blood picture frequently should be done.
-vitamin b12 levels
-kidney function test
-LFT
-FAI( free androgen index).

Imaging:
-MRI ,x ray for inflammation of blood vessels and brain tumor or infections.




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