62 year old female with burning sensation in right hand fingertips

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A 62 year old female, herder by occupation, came with chief complaints of

• H/o fall on 28/3/22 at 8 PM and 29/3/22 at 3 AM
• Pedal edema till above ankle since 1 week 
• Burning sensation of right fingertips since 2 months 
• Dryness of mouth and inability to swallow since 2 months 
• Drowsiness since 2 months 
• Generalized weakness since 1 year 
• Ear pain and ringing sensation in ears on and off since 2 years 

History of presenting illness: 

Patient was apparently asymptomatic 2 years back and then developed burning sensation of right fingertips since 2 months, which is constant, increases on activity such as mixing food or combing hair. There is no bluish discolouration or paleness of fingers . 

She has history of fall on 28/3/22 at 8pm when she went to take a bath, she sat on a stool and fell back. 

At 3 AM, she woke up to urinate, went to the washroom and sat in squat position, before she could support herself with her hands she fell on her face and that resulted in a swollen right eye.

 

2 months back, after getting down the bus, she landed on a sloped surface, lost her balance and tumbled down. She lost her consciousness for 5 minutes and was later woken up by her daughter and was given water. She walked back home after this episode. She had trauma to head and laceration on her left arm. 

Dryness of mouth since 2 months associated with intolerance to solid foods. She apparently can only swallow if she drinks water along with her food. She feels like her voice has also changed as she feels pain on trying to talk. 

She feels excessively drowsy since two months, her attenders tell that she prefers sleeping most of the time and is not doing her chores. 

She experiences generalized weakness ever since her husband passed away away due to uncontrolled sugars(both his legs were amputated). 

She experienced pain in both her ears associated with ringing sensation, 2 years back. Not associated with any discharge or loss of hearing. She used ? Medication for it and it reduced. But the ringing sensation does come up occasionally. 

She has pitting type of pedal edema till above her ankle. 

Past history: 

On observing, her mouth is deviated to right side, when asked she reveals she experienced an episode of stroke 5 months of age. She says they used a lot of herbal medicine to correct her deviation. 

3-4 years on regular check up she was diagnosed with Diabetes Mellitus and is on medication for it. 

General examination 

Patient is conscious, coherent and cooperative. 

Pallor is present. 

No icterus, cyanosis, clubbing, koilonychia, lymphadenopathy. 

Temp: 98.5

PR: 90 bpm

BP: 110/70 mm hg

SpO2: 98%

 




Thickening of skin present on her right middle finger. 

CVS: S1 S2 present 

No murmurs, thrills heard. 

RS: BAE present, NVBS heard. 

CNS: E4V5M6

HMF: intact. Conscious. 

Tone:   R.     L

UL.     N.      N 

LL.     N.      N 

Power:  R.     L

UL.       5/5.  5/5

LL.       5/5.  5/5

Reflexes:    R.     L

B.               ++.     ++

T.               ++    + +

S.               ++     ++

K.               ++    ++

A.               ++     ++  

Investigations: 

RBS: 164 mg/dl

Se. Creatinine: 1.2

Se. Uric acid: 11.1

Blood urea: 41

Na: 138

K: 4.8

Cl: 101

LFT: 

Db: 0.16

Tb: 0.57

AST: 64

ALT: 57

ALP: 204

TP: 8.0

Albumin: 3.6

A/G ratio: 0.89

Chest x ray: 

ECG: 

2D ECHO 

Diagnosis:

Raynaud’s phenomenon with AKI

? Scleroderma 

Treatment: 

1. Tab. NIFEDIPINE 10mg TID 

2. IV FLUIDS 2 NS 

3. Inj. ACTRAPID 10 units 

(Morning- afternoon-night)

4. Tab. FOLITRAX 7.5mg once a week 

Every Wednesday 

5. Tab.FOLIC ACID 5mg once a week on Tuesday. 

https://caseopinionsbyrollno156.blogspot.com/2022/03/62-year-old-female-with-burning.html

New admission

ICU 6th bed

30/3/22

S: 

Burning sensation in right fingertips 

Pedal edema till above ankle 

Dryness of mouth 

O: 

Patient is conscious, coherent and cooperative. 

Pallor is present. 

No icterus, cyanosis, clubbing, koilonychia, lymphadenopathy. 

Temp: 97.8

PR: 99 bpm

BP: 120/70 mm hg

SpO2: 98%

CVS: S1 S2 present 

No murmurs, thrills heard. 

RS: BAE present, NVBS heard. 

CNS: E4V5M6

RBS: 164 mg/dl

Se. Creatinine: 1.2

Se. Uric acid: 11.1

Blood urea: 41

Na: 138

K: 4.8

Cl: 101

LFT: 

Db: 0.16

Tb: 0.57

AST: 64

ALT: 57

ALP: 204

TP: 8.0

Albumin: 3.6

A/G ratio: 0.89

A:

Raynaud’s phenomenon with AKI

? Scleroderma 

P: 

1. Tab. NIFEDIPINE 10mg TID 

2. IV FLUIDS 2 NS 

3. Inj. ACTRAPID 10 units 

(Morning- afternoon-night)

4. Tab. FOLITRAX 7.5mg once a week 

Every Wednesday 

5. Tab.FOLIC ACID 5mg once a week on Tuesday.

ENT referral done I/V/O dryness of mouth, difficulty in swallowing solids. 

30/3/22:

Hb:8.3 

TLC: 8000

N/L/E/M: 50/35/5/10

Plt: 1.87 lakh

Se uric acid: 11.5

HbA1c(30/3/22): 6.5 %

LFT: 

Db: 0.17

Tb: 0.6

AST: 55

ALT: 52

ALP: 197

TP: 7.7

Albumin: 3.53

A/G ratio: 0.85

X Ray to look for calcifications

 

Opthalmology referral to look for Roth’s spots to rule out Infective Endocarditis